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Cold Feets

December 9, 2012 in General interest

As you are going through your Physician Assistant program you get inundated with this huge amount of info. Every minute of every class is jam-packed with information that you will be expected to know when you graduate. Not just so you can pass a certification exam, but so you don’t kill somebody when you finally start working as a full-fledged Physician Assistant. At some point in time when all this knowledge is being packed into that head of yours, you are going to wonder; “Will I remember all this? Will it all stick?” Hell, you might even be so brazen to ask your professors those very same questions. (I did.) I asked my professors, fellow students, preceptors, my wide, the school librarian, my parents, and anybody else I thought might give me some glimmer of hope that all this stuff I was learning was not just flying out as fast as it was being flown in. As it turns out the answer I received from everyone was essentially the same. “Trust yourself, when the time comes the information you need will be there for you.” I swear it felt like I was asking Master Yoda about this. I mean what is this “trust yourself” crap. C’mon people, I turned to you for advice about a very serious concern I have over my ability to consume, digest, process, and then regurgitate enormous amounts of information that will become essential to my ability to keep someone alive and you give me this sh!+ about “Trust yourself, it will be there for you”. What kind of half a$$ answer is that?

Well, as it turns out, it is the right kind of half a$$ answer. These people weren’t just feeding me some Freudian BS to make me feel better. They were actually right, for the most part anyway. As you get out in the real world and start working on your own, it’s amazing how things you spent time studied just come out when you need it. I am always a little surprised when I recall some arcane bit of knowledge about a problem or drug just when I need it. (Proof that I am not as thick headed as some of my high school teachers asserted. Stuff does stick in there. Kiss my A$$ Mrs. Glaze.) Sorry about that, got carried away.

As I was saying, the folks that I was grilling about my questionable memory prowess were only partially right. The information you need to perform well as a Physician Assistant is tucked away all nice and neat in your head, and it will be retrievable most of the time when you need it. Yes, I said most of the time. I am sorry to be the one to break this to you, but at some time in your career you are going to either not remember something that you damn well know you should be remembering or just not know what the hell is going on with a patient. It happens, believe me; it happens. The question is, how are you going to deal with it? You are sitting in the room with a patient working up some old lady’s sore throat and she breaks out with “How does my Sjogren’s syndrome affect the enamel of my teeth when I drink too much orange Kool-Aid and the temperature is below 72 °F during a full moon after swimming all day in public pool?”

WTF!!! HOLY SH!+, IS THIS PATIENT F’N SERIOUS?

Answer; yes, they are serious. So what do you do? How do you deal with this patient’s question? Well, if you are really good you will tell them that the enamel on the teeth will only be affected by Sjogren’s when drinking grape Kool-Aid and the temperature is above 72 °F during a half moon and swimming in a private pool. (OK, I made that up). The point is that this patient is expecting an answer to the question and you are not going to have a clue how to give them one. How to deal with the scenario of “not knowing” will not be covered in school. Why should it, your school is extremely confident they taught you everything there is to know about being a Physician Assistant. (FAT CHANCE OF THAT!)

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Cheesecake for lunch again?

April 23, 2012 in General interest

Sorry about being away for so long. Real life has been taking its share of my time, keeping me away from the computer.

I have been dreaming a lot recently about what I would do if I was not a Physician Assistant? Like what would I do if I could do anything I wanted? I thought that being a fireman would be cool, but my groin chafes easily in the heat so this might not be the best idea. Then I thought about being an astronaut flying around the stars and exploring the galaxy, but I get really queasy during long trips so maybe not. Oh, I know. Start working on my acting career. “To be or”… this is not to be. How about spending my days hanging around in a strip club? Yeah, that would be great. Getting free food, having gibbering big busted women running around in tight clothing pushing their breasts all in my face and telling me a bunch of lies about how awesome I am in order for me to feel better about myself. If they manage to stroke my ego just the right way, I will become a bumbling idiot that has lost all common sense and while I am dribbling all over myself these ladies are making some serious bank.

Wait a minute!

That’s not a dream. That’s actually what happens every time a pharmaceutical sales rep comes in my clinic. They show up with their mindless prattle and hope that my glans penis will take over my thought processes while the grey matter takes a back seat. A veteran porn star could not make “renin-angiotensin-aldosterone system” sound as sultry and inviting as a well-trained Benicar rep. I swear, when I have the money and time (and the ok from the misses – never going to happen), I am going to make a real porn called “Pharma-screw-tical Reps”. When I was a student out on clinicals I thought it was the coolest thing in the world for a pharmaceutical rep to give me the time of day. I would whip out my spiral notebook and start scribbling down every word. Asking all kinds of questions; “So how do you spell fenofibrate?” I thought that these educated people were trying to teach me something. What an idiot I was.

Listen up Physician Assistant wannabes and Physician Assistant Pups, don’t be an idiot like I was. These pharmaceutical reps are not in any way interested in teaching you anything. They are focused on one thing and that thing is increasing the amount of prescriptions that are written for the product they promote. The goal for them is to brainwash young prescribers, convince them of the superiority of the “new” medicine so that you will blindly write for that product. To say that pharmaceutical reps are trying to educate you about medicines is like saying Adolf Hitler was just trying to teach people how to make camp fires. As an upcoming Physician Assistant you have to always be considering the motives of the pharma rep. Which as it turns out is reasonably easy since they only want to sell more drugs.

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Yeah, I’m “JUST” a Physician Assistant

April 1, 2012 in General interest

I had a very interesting encounter with a patient’s mother the other day and wanted to get some feedback from the Physician Assistant community on what you would have done? I am curious, how you would handle this situation?

This 25 year old Asian female presents to the clinic with a chief complaint of vaginal odor and some discharge for the last 3 days. I walk into the room, introduce myself and begin gathering some history from her. She is a sexually active female with multiple partners. She does not “need” to use condoms for protection because she takes birth control pills. She denies any other symptoms other than the “fishy odor” and mild discharge. I hope this is sounding like bacterial vaginosis to you, because it sure did to me. Our clinic is not the fanciest, we don’t have slides available to confirm with KOH or look for clue cells. We generally make this diagnosis clinically. I do like to do a urinalysis, pregnancy test, and STD screening. If the patient does not respond well to treatment, then we will work this up a little further with a vaginal swab. I explained to the patient a plan of treatment that included a few labs and a prescription for Flagyl to treat bacterial vaginosis. She asked me if it was ok to go get her mom from the lobby. Mom apparently is a certified nursing assistant and the daughter likes to run things by her.

“Sure, no problem. Bring her in.” (Stupid mistake)

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Family Jewels

March 23, 2012 in General interest

So I have had this idea brewing in my head for my next blog, but have been unsure of exactly how to get it started and I decided (finally) to get it started with a story. Well, several stories actually.

(I sh@# you not, these are actual clinic encounters that I had. Even Stephen King could not make crap up this good.)

I have this 22 year old Vietnamese female with a complaint of left ear pain. She is accompanied in the exam room by her two sisters and her mother. After a brief exam it is apparent that she has a cerumen impaction. (Gobs of ear wax stuck in the canal for those who don’t know.) The treatment for this is pretty standard. You get the ear wax out and presto chango, the ear stops hurting and the patient can hear again. In my clinic we use a lavage technique, basically irrigating with water until the plug-o-wax pops out of the ear. So I explained what I wanted to do with the ear, how it will feel and how she should expect to feel afterward. After some quick Vietnamese banter between the five of us (I don’t speak Vietnamese, but I did nod my head yes a lot while they spoke); myself, the patient, the two sisters, and the mother all agreed that this would be the most appropriate next step. Read the rest of this entry →

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Show Me the Money

March 9, 2012 in General interest

Congratulations, you made it! You completed all the required courses of study to become a full-fledged Physician Assistant. You went on rotations as a student in real clinic settings and were judged by your preceptors as having the skills and knowledge to become a full-fledged Physician Assistant. You passed the six hour NCCPA exam, you were granted a medical license from your state, and given a DEA license number to become a full-fledged Physician Assistant. Now it is time to get out there and work like a full-fledged Physician Assistant. Finally you get a chance to make your own decisions about the care of your patients. No more professors, or preceptors or anybody telling you what to do with your patients. Your first patient of the first day on your first job is in the exam room and ready for you. You review the chart; he is a 55 y/o male with no significant medical history. His blood pressure is 142/86, and he weighs 206 lbs. You make a mental note to talk to him about his weight and elevated blood pressure. You stand up, check to make sure the PA-C name tag is prominently displayed, stethoscope ready, pen is working (lets do this). You walk up to the room, knock on the door, walk in and are ready to bust out with some serious medical knowledge. This guy is so lucky, he is about to get the best medical visit of his life. You start to talk to him and it turns out he is here for his annual physical exam and blood work. He has a family history of heart disease (his father died of heart disease at 75). Otherwise, he has no real complaints, feels fine, and states that his blood pressure always comes up when he comes to the doctor’s office. His physical exam is unremarkable and yes, you did check the prostate.

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“I’m not a doctor, but I play one on TV” part un

February 24, 2012 in General interest

Sometime in like 1986’ish Peter Bergman did this Vicks 44 cough syrup commercial and according to Wikipedia he was made to say “I’m not a doctor, but I play one on TV” so people would not think he was a real doctor. This little phrase has become the stuff of legends. Embedded in the fabric of our pop culture. Sort of the go to phrase when your drunk buddy has an epic fail and ends his fall with a no handed face plant. As his nose bleeds profusely, you chime in “I’m not a doctor, but I play one on TV” and that was @&^%!*@ funny. Just the thing to say to a room full of ladies in your most debonair voice with your left eyebrow raised just slightly. At the minimum, you could get a few good laughs. I mean its freaking hilarious; the thought of this soap opera actor stating outright that he is not a doctor  and then telling us how good Vicks 44 cough syrup is. Hil-lar-ious!

You know what’s not so hilarious?

The fact that you will be explaining to your patients outright that you are not a doctor, then telling them how good Vicks 44 cough syrup is!

Don’t forget to take the “I’m not a doctor, but I play one on TV” poll.

Get used to it; “I’m not a doctor, but I play one on TV.” Practice it in the mirror. Become comfortable with it, because at times you are going to feel like “I’m not a doctor, but I play one on TV.” When patients insist on calling you doctor, even though you have told them over and over that you are the Physician Assistant; you might think “I’m not a doctor, but I play one on TV.” Do not let this cancer creep into your psyche, hold your chin up. You are a Physician Assistant.

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“I’m not a doctor, but I play one on TV” Part Deux

February 24, 2012 in General interest

If you have landed on this page and are not sure what the hell I am talking about, go to “I’m not a doctor, but I play one on TV.” Part Un. Read that blog then return here and you should be all up to speed. Also, don’t forget to take the “I’m not a doctor, but I play one on TV.” poll after this.

So, this is the second portion of “I’m not a doctor, but I play one on TV.” I never imagined this blog would become so large. I got started on this with one simple word scribbled down in a notepad, “DR”. I wrote it down on a day when I had seen a good number of new patients and had to correct most of them when they said “thanks doctor”. It reminded me of when I was a very green Physician Assistant and it felt like I was correcting people all the time about my title. I started questioning exactly what was I doing? Am I just pretending to be a doctor or am I serving some unique function in the health care system? This phrase “I’m not a doctor, but I play one on TV” kept popping into my head. Literally making me laugh out loud. Of course I have matured in my role as a health care provider and no longer question what I do or who I am as a clinician, but that phrase has been stuck in my head since then. I want those who are looking into becoming a Physician Assistant (I call them wannabes) and those new Physician Assistants (pups) to really understand what they are getting into. Who knows maybe one of them, or one of you have said to yourself “I’m not a doctor, but I play one on TV.”

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Top 9 reasons to become a Physician Assistant

February 17, 2012 in General interest

Top 9 reasons to become a Physician Assistant

(This is the list that the admissions counselor at the school you have been eyeballing for the last year won’t tell you about.)

1) Enjoy patients asking, “Where is the real Doctor?”This comes in several forms, including “Is there a real Doctor here?” and “Oh, you’re not a real Doctor?” Don’t let this well laid verbal trap get you all worked up like some PA’s do. Be relaxed and calmly explain who you are and what you do. I will commonly let this kind of patient know that I will lay out a treatment plan, but will run it by my SP for agreement before we implement it. As time goes by the patient will gain confidence in the treatment options I put together.

2) Want to give up Saturdays and Sundays as well as a few weeknights a month to take call so your Doc can sleep in.
Nothing beats you down more than feeling like you are working for free, while the Doc is still in his/her PJs. Trust me, been there. Some specialties (think surgery and hospitalist) just have to take call. It’s part of the gig. The best way to keep from blowing up at that 2AM page from a nurse asking if she can use a bedpan instead of a bedside urinal on your patient; is to know that you are getting paid for it. (By the way, I actually took that call from a nurse about one of my male patients.) Make sure that if you have interest in a position, or are up for renegotiation of a contract that includes taking call that you have a payment schedule built in for it. You should ask for extra pay for being on call and additional funds if you have to travel to the hospital.

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So what is a Physician Assistant anyway?

February 14, 2012 in General interest

One of the most frustrating aspects of being a PA is having to explain, to just about everybody, what you actually do. When I was in school the program directors and faculty brushed over the fact that a PA will need to be able to articulate their function in the clinic to patients. I naively thought this would be a random occurrence that was isolated to a few patients here and there.

I COULD NOT HAVE BEEN MORE WRONG.

I find that I have to explain what a PA does to patients at least 3-4 times a week. Add to that the 3-6 times a month that I break down what we do to non-patients (friends, family, acquaintances). I have even had to repeat the same explanation to the same patient twice, on two separate visits (He counts twice). As you can see, it starts to feel like nobody knows what a PA is or what we do. The scenario I see the most is when I walk into the exam room, introduce myself and in response I get the proverbial deer in the headlights look.
I stare at them; they stare at me.
On cue….3….2….1.
They ask, “What’s a PA?”

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You’ll Never be Number One!

February 10, 2012 in General interest

I just want to blast it out there from the get go.
YOU WILL NOT BE NUMBER ONE!!

Most of the people that I know that are PA’s or aspiring PA’s have an internal drive to be the very best at what they do. They take pride in success. They work hard at becoming increasingly knowledgeable in their chosen field. They were overachievers in school. They are without a doubt very intelligent people.

In a nutshell they have been number one. Always pushing for that top spot in the class. Always had their hand up to answer questions. Spent more time in the library to ace the test. Like I said number one.

The bad news for you is that becoming a PA, automatically demotes you to number two. That is the highest rank you can possibly achieve as a PA. No matter how much you work, study or push; you will remain number two.

It is important for you to understand this before you go off and commit yourself to becoming a PA. It’s by design, this number two business. As a PA you are dependent upon a supervising physician in order for you to hold a job and function as a PA. PA’s do not hold a license to practice without a supervising Physician. That supervising physician will always be the number one.

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