Archive | November, 2014

What To Do When Your Crew Wants a Few

21 Nov

pills

After graduating from a PA program in 2007 a peculiar thing happened. Everyone wanted a prescription. Parents, siblings, spouses, neighbors, the garbage man….they all seemed to think that I could help them out.

“I just need an antibiotic!”, they say. “I’ve been coughing for a week!,” they say. “I know its a sinus infection!”, they say.

Well, all you new grads, don’t do it! When you are just out of school, the power of prescribing can be intoxicating. You feel on top of the world and the fact that the garbage man recognizes your newly minted place in society is pretty cool. But there are so many pitfalls.

1) You might lose your license.

2) Setting a precedence with friends and family that you are a go to person for desired prescriptions can create awkward and tense moments when you finally say no.

3) What if you are wrong? What if you give someone an antibiotic for a suspected sinus infection and they actually have an infection burrowing though their sinus into their brain? You don’t want that on your conscience.

4) Did you check their chart for any drug allergies? Didn’t think so.

5) In fact, did you check their chart for anything? Past medical history is kind of important to know before starting any new prescriptions. What other meds are they on? Oh, the neighbor forgot to tell you they were on coumadin and now you just contributed to internal bleeding. Ouch!

There are times when I have been flexible about prescribing to people that are not my patients. And I have had colleagues help out when I developed very classic signs of a UTI. These instances are few and far between, and every time I weigh my risks. I once prescribed a stronger steroid cream to a PA friend of mine at work, who actually showed me the rash first. She begged and I caved…but believe me, the decision wasn’t taken lightly. But, I strongly encourage new grads to steer clear of this as you are new to the field. You need a little more experience before you consider prescribing outside the clinic setting. How are other people handling this issue? Do you help out or do you have a strict policy against it? Let me know in the comments section!

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My Gallbladder Hates Me

13 Nov

deepfriedbutter

Two nights ago it happened again. I woke up at 2:30 in the morning because of  searing pain in my right upper quadrant. I heard a small voice from my abdomen say, “I’m baaaaaaaack”.

Damn you, Gallbladder! It decided to keep me up writhing in pain for 3 hours until my pain medicine finally kicked in enough for me to sleep. When I awoke the second time at a decent hour I was forced to lay in the fetal position and massage my belly. I am currently on my “gallbladder diet” which consists of nothing. The gallbladder diet is… nothing. No sugar, no cheese, no coffee, no gluten, no soda, no eggs, no nothing.

If you don’t know, the gallbladder is a little devil that lives under your liver and stores bile. This bile empties into the small intestine and helps break down fats. There are a number of reasons why you can have problems with the gallbladder.  Genetics, diet habits, lifestyle, all can play a role in creating a problematic gallbladder.  Two years ago I was diagnosed with a lazy, devil gallbladder and I saw a surgeon. There was discussion of a cholecystectomy, or removal, but I wasn’t quite ready to part with it.

This is where my story might sound strange to many of you. I work in the ER, in a place that generally favors western medicine. In my own time of crisis I chose eastern medicine. After seeing my surgeon, he agreed to oversee me trying acupuncture and diet changes to cure my ailment. No more fried butter! I did acupuncture three times a week for two months, and slowly tapered down for a total of six months. That is dedication, people! I did make some big changes of my diet, which made an impact on other areas of my health as well. For two years, I was pain free. I never had to go back to my surgeon’s office, or see my acupuncturist.

Fast forward to present time. Family stress for the last year, and more in the last five months. Fast food runs, diet pop, cigarettes, sugary comfort foods. I should have known the little devil was getting ready to pounce! I literally had lunch with my aunt the day the pain came back. I was eating deep fried french toast when I said to her, “I feel like I’m playing Russian Roulette!” So now I’m back to square one. Its a little disheartening. I have to reset my body and will check back in with my surgeon.  Until then, I will go eat my beet salad and take my supplements. Hopefully that will shut down the little devil reeking havoc on my insides!

On a side note, always see a medical professional if you are having abdominal pain. Do not attempt a diet change without seeking the advice of your primary care clinician.  This little blog piece does not substitute seeing your practitioner.

Has anyone else had a positive experience with “alternative” medicine?  Do any of you clinicians out there use alternative medicine with their patients?

Today’s Debate: NP vs PA

9 Nov
fight

Bam! Slam! KaBOOM!

The oldest question in the universe? Should I be a physician assistant or a nurse practitioner. As many of you know, this question gets asked all the time from pre grad school students. Which is better? At the risk of being ostracized by my professional organization I am going to go out on a limb here….WE ARE EQUAL!

I work in the ER with very talented PAs and NPs. We own that place! Advanced practice providers are well utilized in my practice setting and we are well supported by our supervising MDs. I never worked with an NP prior to my current position but I heard a lot of rumors before I started.

Here is one falsehood that I frequently heard. NPs aren’t trained in the medical model, therefore they don’t have as solid of a background when compared to a PA. Well, that’s nice. Here’s the truth. NPs have strong programs and though they may have a different emphasis, they are well prepared for the clinician position.

Here’s a question, how many of us PAs feel like we didn’t really start learning until we started working? My “on the job” training was much more valuable than the classroom setting. My degree is awesome, and I am proud of what I accomplished. I also have no illusions that I was a stellar practitioner the day I stepped out of my program. Just like us, NPs have a learning curve when they are out of school as well.

There is some bad air between the NP and PA professions. We undermine each other and it isn’t helping the advanced practice provider (APP). I’ve heard negativity coming from the NP side as well. The truth is, I believe all of the bickering is coming from insecurity. We all had to fight to make our career choices “legitimate” in the eyes of the public. We all had to prove ourselves to the medical world. The truth? There is enough room for us both.

If you are wondering which career path to take, I can’t help you. You have to look at your end goals, your timing, your financial status. The one thing I know is that both careers are changing the healthcare system for the better. If we support each other as equals, we will have a louder voice to direct legislation that affects our reimbursement, scope of practice, and new practice opportunities. So, don’t undermine each other! I know that both types of practitioners will benefit from more cooperation. What has been your experience? Comment below!

Cleaning Cheats for Working Mamas

6 Nov
cleaning pic

I don’t know what half these gadgets are, but someone must use them?

Working irregular and odd shifts in the ER make one thing certain, cleaning my house is not a regularly scheduled event. I have three little ones and to say that I was an overly organized or clean person pre-kids would be completely false. But I do have standards people! Low ones for the cleanliness of my house but with these tricks you would never know it. Yes, I have found a way to deceive the average visitor into believing that my house is somewhat clean. Feel free to read about my short cuts….just don’t judge!

1) Every night I use my washcloth that just cleaned my face to clean the mirror and sink. Having a spotless mirror and sink creates the illusion of a clean bathroom. My kids leave 3 foot snakes of toothpaste in the sink which looks disgusting. Seconds after I wash my face, the sink and mirror are relatively clean. I do use a clean wash cloth every time. Standards people!

2) Quit sorting your laundry. I haven’t sorted laundry for 3 years and you would never know it. I wash everything the same way. Throw a bunch of clothes in (whites and colors), put in the detergent, and always wash on warm. Here’s an extra-super-time-saver tip: Never wait for the tub to fill. I always put the detergent in the cap directly into the washer. It just kind of spills out once the tub is filled. No need to wait for the water to fill up!

3) I don’t remember the last time I mopped the whole floor. I ain’t got time for that! Spot clean people. A little syrup spill over there, mud tracked in over here, glitter glue up…on the ceiling? Just wash the offending areas. I try to do that right away once the spill happens so it comes up easier. Some spills you just have to wait. Rice? Way easier to sweep once dried up. People actually have asked how I keep my floors clean. HA!

4) Get rid of crap. Seriously. I am a minimalist not because of any higher ideologies but because I don’t want extra things to dust. If you don’t absolutely love it and it just gathers dust, put it away. Either store it or bring it to good will. Always streamline. And if you buy something new, throw something out.

5) Back to the bathroom. I clean my toilet while my kids take a bath. It takes 20 seconds and ends up happening a few times a week. My kids get lots of baths cause someone is always rolling in something.

6) If your kids are old enough, they need to help around the house. Do you realize how much making a bed creates the illusion of tidiness? Get them in the habit and even if there is mass chaos on their bedroom floor, there is at least one area of calm.

7) My kids know that if they leave projects, crafts, toys out on the floor, there are absolutely no guarantees. If I lose my mind one day, those toys are going into a bag and will never be seen again. They do pretty good about picking up, and a little allowance never hurts.

8) When my third baby came along there was a year long period that I paid someone to clean my house once a month. It was bliss on those days. Very rarely does my entire house get clean on one day. If you have a little extra money and your sanity is at stake, a cleaning service is worth every penny.

9) If you are really behind and feel like you just can’t get your head above the dirt I recommend the fly lady. www.flylady.net  She makes getting the house in order kinda fun…kinda.

10) I know that sometimes disorder happens. Or maybe all the time. Don’t feel bad, working mama! Take one little task at a time and make sure that everyone is participating and on board with keeping the house livable. That’s all we need, right? Just….livable. What kind of cheats have you come up with? Share with us below!

How to Go to Work When You Are Sad

5 Nov
rain

Sadness Comes, Even When You Have to Work

Working with sick people is hard. You see young people stricken with illness, fathers and mothers take their last breath, depressed people try to end their own lives. I was made for this stuff. For some reason, God wired me in such a way that I can help people with just the right amount of protection so that I don’t come home a sloppy, tearful mess every day. That was, until my dad was diagnosed with cancer.

Fall of 2013. Doing my thing, taking care of my kids, going to work, staying the course. Suddenly I find myself down at Mayo to visit my dad because they found he had a showering of PEs (blood clots) in his lungs. And a mass.

Soon I found myself back at work. At first I kept the fact that my father had cancer to myself. The fact that he suffered two strokes because the cancer liked to make clots and fire them off to critical parts of his brain was my tightly held secret.

The ER has a perceived grit. A toughness. We go to work unless we physically can not. Maybe this is my own misconception, but I was scared to tell my coworkers and supervisor that my dad was getting sicker. I didn’t want to be viewed as the weak link, when in fact, maybe I was. I couldn’t keep it a secret anymore.

Here is what I observed in my own life that maybe will help you if you ever (God forbid) find yourself in my situation. I was distracted at work. I couldn’t concentrate. Decision fatigue would creep its way early into my shift. The worst, WORST, part of going to work while trying to deal with cancer? The fact that I could no longer separate myself emotionally from my patients. When my dad was diagnosed with cancer, suddenly every one of my patients also had the same affliction. Or at least it felt that way. I would be sitting with my patients and their families and listen not only to the reason they came into the ER, but the entire back story of why they decided to stop chemo, or how sad the family was when they learned of the diagnosis. There were stories of hope and loss. Taking their history suddenly went from a 15 minute, straight forward event, to an hour of shared stories and tears. This is not how an efficient ER is run.

I finally broke down and told my coworkers and my supervisor in December. It was a good decision and it gave me a little more room to breath. My attending doctors often times would encourage me to see a decreased patient load, to take a break if I needed, that if I wanted to take less complicated patients that would be okay.

Soon, my dad’s cancer became my new normal. The shock wore off and I was able to put my head down and work. At least I was able to make it through a shift without crying. I created a list that may help those that are struggling with a similar situation. It isn’t a happy list, but maybe you won’t make the same mistakes I did.

1) Talk to a supervisor early. Maybe they can temporarily decrease your workload, or adjust your position until you are back on your feet.

2) Don’t be afraid of talking to a professional. There are many of us who work in the healthcare field that see this as a sign of weakness. I call it survival.

That’s it. That’s my list. When it comes down to it, there is no good way to deal with tragedy. It will change you and it will change your practice style. I know that I am a more compassionate provider because of all my family went through last year. And I have less ability to put up with bull shit. Jury’s still out about if that one will propel or hinder me in my career. The thing is that when someone you love is hurting, it hurts you too. There is no easy way, short cut, or fast track to dealing with it. The sadness becomes a part of you and sits uncomfortably on your shoulder. I got used to it, for better or for worse.

Sexism in the PA Profession

3 Nov
angry-woman

My free images are limited so this is the best pic I could find for this article 🙂

Today I am calling all feminists. Think back to the years when we were idealists and thought that an individual was capable of making change. When men and women cared about justice and equality. There was the occasional protest maybe, or possibly the burning of unmentionables. We need to grease the joints a little, and get back on the horse.

I was reading an article yesterday on the website called PAs Connect. There was an article there titled Gender Wage Gap Persists for Physician Assistants  What I read there made my muscles twitch and my eyes bug out a little.

I know that women generally make less than men, and there is that whole glass ceiling thing. But PAs and other health care professionals are enlightened, progressive, educated people, right? As it turns out, female PA’s make 29.3% less than their male counterpart. There is a salary difference in almost all areas of healthcare, from dentists to pharmacists. According to the article, we are actually doing worse today than 15 years ago.

Can we take a moment to say “What the heck?!?”. What has happened to feminism and to outrage at these discrepancies? I researched a little further and found multiple articles stating the same thing. Women in healthcare doing the same job are making less. This is true in the physician world as well. Just take a look at the JAMA article from last year titled  Trends in the Earnings of Male and Female Health Care Professionals in the United States, 1987 to 2010.   This article states that,

“A gap in earnings between male and female US physicians has persisted over the last 20 years. Although we adjusted for differences in hours worked and years of experience, our study was limited because the CPS does not include data on specialty, practice type, procedural volume, and insurance mix, all of which could influence our findings. Our inability to adjust for these factors likely explains why we found a gender gap in earnings in 1987-1990, while a previous analysis in this period that adjusted for these factors did not.1 Recent studies suggest, however, that gender differences in earnings still exist even after adjustment for these factors.”

Why do women make less? Maybe its true, women aren’t as valuable. They’re not as smart, not as talented, and are too dramatic. I refuse to believe this. In the ER, I see women kicking butt. I see them seeing complex patients, reducing joints, sewing people up, intubating, splinting, and at the same time showing compassion and walking patients through some of the most difficult time in their lives.

I am mad. And I am calling you to be mad with me. We are not going to accept the status quo. So the next step is what…..I am a little rusty on the action part of this. If you have any ideas, please comment below, and please share this article. This is an important issue and we need both men and women to support equal wages.

 

 

 

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