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@Boatswain2PA I couldn't imagine being constantly and consistently called a racist, bigot, behind the times etc everytime I voiced my opinion. That's got to, in the words of a millennial, suck.

How many times are you going to say "woke" Boats?  We get it, you are a Tucker Carlson and Shawn Hannity guy.  Everyone knows what you mean by it.  You inject politics into virtually all of your posts

I think we might be a little off the track a bit. If you look at the statistics, there usually at least 10 times as many guests here than members. We probably all started out as guests and decided to

I think they wax and wane depending on what issues are happening. I have always been surprised by the number of people I speak to offline who tell me about conversations they have been following without commenting.

I'd add a lot of people listen but are timid about jumping in for fear they "don't know enough" or will get flogged for something they say.

I get flogged a lot. You get used to it.

Edited by sas5814
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I have noticed the same thing when I go to a few social media sites. Leadership on any level in professional associations and in churches and other religious institutions usually average 4%. Involvement in the PA profession is probably 10 % due to the new PAs but we seem to be missing the boat. I, too, have spoken with colleagues who recognize my name on social media sites and have read one or more of my articles but they rarely, if ever, comment. I guess we will never get gratification from our attempts to make this a more cohesive and unifying profession. Name change is our largest issue of interest. A bit self serving?

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When you’re retired and getting flogged on boards (“old man, give it up”), it gives you something to be excited about and to look forward to the next day when you wake up.  On the Professional PA General Discussion it does seem to be the same folks replying to questions.  As I’ve noted in the past, I think that this particular board has the opportunity to provide a service that few take advantage of and that’s to bounce case scenarios, treatment options, etc. off folks.

Case in point, there was a YT posted podcast that I watched the other day for Cat II CME as I debate whether to renew my license or not in August, and it was a local EM PA and a NP out of EMEDPA’s neck of the woods discussing sending home a patient with a corneal abrasion with a topical anesthetic as well as opioids for pain management.  My response would’ve been no because I don’t trust the patient to use it appropriately (from my old ED days) and I don’t recall ever giving pain med to a corneal abrasion (which doesn’t mean that it couldn’t have been helpful necessarily).  The discussion, along with an EM physician who appeared, resulted in their deciding that the above could be considered appropriate.  I just gave them emycin ointment to sooth the eye and told them to see ophthalmology if not improving within 36 hours (they always came in during the afternoon/evening hours).  No mention was made as to inquiring about the tetanus status...

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17 minutes ago, GetMeOuttaThisMess said:

 

Case in point, there was a YT posted podcast that I watched the other day for Cat II CME as I debate whether to renew my license or not in August, and it was a local EM PA and a NP out of EMEDPA’s neck of the woods discussing sending home a patient with a corneal abrasion with a topical anesthetic as well as opioids for pain management.  My response would’ve been no because I don’t trust the patient to use it appropriately (from my old ED days) and I don’t recall ever giving pain med to a corneal abrasion (which doesn’t mean that it couldn’t have been helpful necessarily).  The discussion, along with an EM physician who appeared, resulted in their deciding that the above could be considered appropriate.  I just gave them emycin ointment to sooth the eye and told them to see ophthalmology if not improving within 36 hours (they always came in during the afternoon/evening hours).  No mention was made as to inquiring about the tetanus status...

Not to derail the purpose of this thread, but here's a nice review of the literature on this. No good evidence sending home with topical anesthetics will impair healing. 

https://rebelem.com/topical-anesthetic-use-corneal-abrasions/

Here's another (new) RCT that wasn't included in that review: https://www.sciencedirect.com/science/article/pii/S0196064420307393

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10 hours ago, Cideous said:

I am just wondering, the same handful of people post on each thread.  

Are these boards dying or am I just missing it?

 

MCP >PA-C.  for the record 😄

I think Covid had an effect as well: a lot of things have changed for me and my family as I'm sure has happened with other folks as well. I found it difficult to want to pay attention to what's going on here, and when I would look, it seemed to be the same old subjects being posted: name change, difficulty finding a job, job unhappiness, etc. After a while, it gets boring talking about the same things, especially negative things and the same new grad dilemmas we've already tried to help with time and time again. 

I am also a member of other social media groups and they provide new things to talk about, mainly memes. Haha. I view this site as more professional and serious, so I enjoy the satire and light-hearted nature of the other sites. 

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Even on the Huddle (I know...I know...its just an example) where arguably 40k AAPA members could participate I'd guess 25 0r 30 people do 90% of the chatting.

There are just so many options that dilute the interest pool. I'm in 4 or 5 relevant FB groups and, if I wanted, could probably fin 10 more without much effort.

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This board is also somewhat seasonal, as far as the pre-PAs go. Lots of stuff in the fall and until New Years, then it drops off. Probably less staying in to pound the keys now and more interest in going outside.

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12 minutes ago, UGoLong said:

Probably less staying in to pound the keys now and more interest in going outside.

Definitely rings true for me. The weather has been awesome lately, and every year I seem to miss it because I am working 50-60 hours per week. So I have been taking full advantage this year now that I have an alternate schedule that gives me more time off. 

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4 hours ago, TheFatMan said:

Not to derail the purpose of this thread, but here's a nice review of the literature on this. No good evidence sending home with topical anesthetics will impair healing. 

https://rebelem.com/topical-anesthetic-use-corneal-abrasions/

Here's another (new) RCT that wasn't included in that review: https://www.sciencedirect.com/science/article/pii/S0196064420307393

Ken Milne from the Skeptic's Guide to Emergency Medicine did the original review I believe! 

He's a good man, supports APCs, I did a podcast with him a couple months ago. Does great evidence based medicine literature review

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11 hours ago, TheFatMan said:

Not to derail the purpose of this thread, but here's a nice review of the literature on this. No good evidence sending home with topical anesthetics will impair healing. 

https://rebelem.com/topical-anesthetic-use-corneal-abrasions/

Here's another (new) RCT that wasn't included in that review: https://www.sciencedirect.com/science/article/pii/S0196064420307393

Also there is no good evidence that we need tetanus boosters, quite the contrary and WHO does not recommend boosters.

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22 hours ago, Cideous said:

Are these boards dying or am I just missing it?

Eventually it'll die a nice, polite, milquetoast death to to political correctness and not wanting anyone's feeling hurt. 

There's no place for discourse in society any longer. It's all hollow-chested men who collapse on the fainting couch in the face of a contrary opinion. Long gone is the time when you could gather for a few beers with very different people and argue. I gave and received many a hearty "Up yours!" in those heady days. Those were better days. 

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On the secondary topic of sending patients home with topical optho analgesics:

I've talked to several optho PA's who all say they've seen/heard of severe corneal damage from overuse of tetracaine/proparacaine.  However, the literature citations they've been able to give me were not RCT's but rather articles, even OP-ED pieces from opthamology journals.

I Rx ketoralac optho.  One optho PA recommended bandage contacts: correction free contacts that cover the corneal and from his experience provide significant pain control.  No where I've worked ever had them.

On the primary topic:

I think it would be very interesting to see what % of all posts are made by the "top posters", e.g. the folks which are in the top 5% of posters.  I expect it to be pretty high.  However, that's been the case on pretty much every discussion board, no matter what topic.

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The PA forum has been around for 22+ years.  Web forums, as a genre, are gone, for the most part--I haven't bothered looking at slashdot in years. Ad experience is annoying for those who don't use ad blockers.  Most every other similar topic is on Reddit--isn't everything?--but not us.  The fact that Huddle attracts the people who 1) want to join AAPA and 2) are fine with opinion censorship in the service of making things 'nice' diminishes our participation somewhat. Trolls and spammers never get onto Huddle, though, because of the barriers to entry. So, we have a set of forums here which do not do particularly badly in a dying format, and we'll likely continue to do so for some time to come.

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11 hours ago, LT_Oneal_PAC said:

Also there is no good evidence that we need tetanus boosters, quite the contrary and WHO does not recommend boosters.

I’d hate to argue this point with the CDC and an attorney.  I’m not saying that it isn’t true or valid, just that I’d hate to argue the point.  Similar scenario as “talking to a male patient about prostate CA”, not getting a PSA, and a year later he’s got prostate CA.  FWIW, at the end of my career I was still leaving the option to the patient after discussing/noting the pro’s/con’s of same.  Most went with it.

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3 hours ago, GetMeOuttaThisMess said:

I’d hate to argue this point with the CDC and an attorney.  I’m not saying that it isn’t true or valid, just that I’d hate to argue the point.  Similar scenario as “talking to a male patient about prostate CA”, not getting a PSA, and a year later he’s got prostate CA.  FWIW, at the end of my career I was still leaving the option to the patient after discussing/noting the pro’s/con’s of same.  Most went with it.

Never said don’t do it, just noting it’s another thing in a long list that we do without, or in this case against, evidence.

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14 hours ago, CJAadmission said:

Eventually it'll die a nice, polite, milquetoast death to to political correctness and not wanting anyone's feeling hurt. 

There's no place for discourse in society any longer. It's all hollow-chested men who collapse on the fainting couch in the face of a contrary opinion. Long gone is the time when you could gather for a few beers with very different people and argue. I gave and received many a hearty "Up yours!" in those heady days. Those were better days. 

Yes there was a time when tempers flared over a poster having the temerity to be contrary to the mainstream thought of others on this forum! I say this having been banned for a while and a few of my online allies have also been banned or just left over the intolerance of thought diversity.  The quote about watering the tree of liberty with blood is applicable to this and many other forums to avoid stagnation and a mutual admiration society from developing.

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In the early 2010s I was active on an EMS forum (EMTlife), and it was fairly livley. Recently I took a peek over there, and the participation and daily posts seem to be 5% of what they used to be. I think the web forum is overall an obsolete medium. But also, there seems to be less interest in general in discussing professional topics online because its not as if the discourse has migrated elsewhere; the PA subreddit is a sad little place where 95% of new posts are "I passed the PANCE!" and otherwise there is nothing of real substance discussed.

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This site is an echo chamber of mono-thought.

Any thought patterns that are not congruent with the mono-thought are allowed to be personally attacked (racist, bigot, boomer, etc) by those of the mono-thought.

There are two regular posters here who do not succumb to this mono-thought.  The others, including myself, have mostly departed.  

I mostly departed because there is a moderator who throws out their mono-thought position, but then closes threads I engage in.  

What does an echo chamber sound like when there is only one sound?

A lot like this.

 

It's not covid.  There are many, many very active discussion boards.  This one turned into an echo chamber and is dying.

 

Edited by Boatswain2PA
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22 hours ago, ohiovolffemtp said:

One optho PA recommended bandage contacts: correction free contacts that cover the corneal and from his experience provide significant pain control.  No where I've worked ever had them.


I’ve used these quite a few times in UC with moderate to larger abrasions that have planned follow up with optho, especially in pediatric patients.. Super easy to put in. Instant relief. Never knew about them until I asked our optho if there was anything else I could offer. Plus I was tired of explaining why we don’t routinely patch/send them home with a bottle of proparacaine. 

“The most concerning reactions from prolonged use include corneal stromal melting and keratopathy with the potential to result in irreversible vision loss.”

 

  1. T., Levent T., Inci M.A. Toxic keratopathy associated with abuse of topical anesthetics and amniotic membrane transplantation for treatment. Int J Ophthalmol. 2015; 8(5): 938–944.

A quick google image search on corneal stromal melting might change the mind of an insistent patient.. 

 

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2 hours ago, Boatswain2PA said:

This site is an echo chamber of mono-thought.

Any thought patterns that are not congruent with the mono-thought are allowed to be personally attacked (racist, bigot, boomer, etc) by those of the mono-thought.

The moderators don't agree with each other on politics, so no, there's no monoculture there.

What has gotten a lot of threads shut down is poster not being able to deal with other people reacting badly, and not reacting badly in return.  It's not limited to one side of the spectrum, and whomever doesn't get the last word when a thread is closed does tend to be less satisfied with the outcome.

Good discourse dies without people who can hold principled positions firmly, debate passionately, act collegially, and argue logically.  I'd be interested to see a thread that went "off the rails" where at least one of these was not a problem.

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You can listen and improve things.

Or you continue your moderation practices and have the same 15 people (13 of which have the same position on everything) do the discussing, while hundreds just check in and see that it's too woke for us to participate.

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