coast2coast, MSN, NP 6,856 Views
Joined Jul 9, '10.
Posts: 404 (42% Liked)
Meh, if you can't beat 'em, join 'em.
"Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."
Since when is it "news" that opioids cause constipation?
This is new?
Not trying to be sarcastic. This has always been a recognized issue.
Is this perhaps a "sponsored" article?
"I have had a similar situation. I had a bad virus infection (as I thought) for more than a week. Progressively, it became worst and I went to see my PCP. Paid $20 co-pay by a check. My PCP was on vacation and the covering bit$& (a female) refused to prescribe any antibiotics. She did not even suggest that I do any lab tests! Frustrated, I stormed out, and went to the walk-in clinic affiliated with CVS, and walked out with my meds. Two days later my infection went away. But, I stopped the payment on my check to my PCP's office. They sent me a bill plus $25 for the stopped payment they had to pay. I responded with a copy of my bill from the walk-in clinic and a copy of prescription bottle, with two questions next to the balance due of $45 - for medical mal-practice? Failure to diagnose? Never heard again from my PCP again."
To me this displays something that is all too common these days, a very low distress tolerance, and this attitude of entitlement, that if they pay to be EVALUATED and assessed by a professional, that it entitles them to be prescribed whatever they want. I actually had a patient who wanted her money back after an 1.5 hour Psych Eval because I wouldn't recommend a stimulant. "But why won't you give me Adderall, I paid for this appointment". Ugh....
I think canceling a check for service provided is wrong. Just because you don't like the diagnosis you got doesn't mean you shouldn't pay for the work that was done. And no, no lawyer is going to call such an episode "malpractice."
Lab test is not necessary for a URI unless strep throat is suspected. Obviously this is all theoretical since I didn't see you personally, but in general if the cold went away within 2 weeks (with or without antibiotics) it is safe to say it was a viral infection. That's what evidences show. So you can't attribute the fact that you got better when you took the antibiotics to the good work of antibiotics. You were on your way to getting better and you happened to take an antibiotic so you think that's what made it better. Again, that's if the whole thing lasted 2 weeks or less and all in theory.
Genetic testing is offered when considering having a child, as well as during pregnancy; one can test for Fragile X syndrome, which is a leading gene in ASD.
My GYN offers genetic testing for fertility, as well as genetic testing for most genetic carrier disorders; albeit my GYN is a part of health system that has been researching genetic testing for most carrier disorders for some time, and now offer pts the ability to undergo testing.
I work for Big Pharma (commence terrified screaming!!!!!!!) and just want to let you know that yep, we are actively trying to kill every single person on this planet. Oh, and Big Foot exists, aliens crash landed at Roswell, and 9/11 was an inside job.
NOW YOU KNOW THE TRUTH
*rolls eyes and heads off to get popcorn. gonna sit back and watch the flamessssssssss*
What happened in 1976 with GBS and the swine flu vaccine?In 1976 there was a small increased risk of GBS following vaccination with an influenza vaccine made to protect against a swine flu virus. The increased risk was approximately 1 additional case of GBS per 100,000 people who got the swine flu vaccine. The Institute of Medicine (IOM) conducted a thorough scientific review of this issue in 2003 and concluded that people who received the 1976 swine influenza vaccine had an increased risk for developing GBS. Scientists have multiple theories on why this increased risk may have occurred, but the exact reason for this association remains unknown.
The link between GBS and flu vaccination in other years is unclear, and if there is any risk for GBS after seasonal flu vaccines it is very small, about one in a million. Studies suggest that it is more likely that a person will get GBS after getting the flu than after vaccination. It is important to keep in mind that severe illness and death are associated with influenza, and vaccination is the best way to prevent influenza infection and its complications
Surely your incredibly biased description of insane "anti-vaxxers" with similarly absent research negates your argument? As there is little research to prove either argument I would say that discussion about the topic should be welcomed until such time that a determination can be made. I believe what I've seen, and from experience I've done many plasmapheresis treatments on people suddenly struck down by Guillain-Barre syndrome after having the flu shot. Research? No. Suggestion? Yes, lots. I don't want to get the flu shot but I am mandated to do so. I am anti forced vaccination. Everyone should have a choice over what goes into their own bodies and that of their children. You dismissing them as some kind of nut-job automatically makes me want to disagree with your argument purely because you dismiss the opinions of other who don't agree with you. We need more research. I'm all for debate, but perhaps your argument would carry more weight without the ridicule. All sides of the argument have extremes. There are degrees of separation and some arguments are more valid than others. I'd love to hear more evidence from both sides.
New idea for Glade: The stool scent collection featuring GI Bleed, C-Diff, and Fresh Flatulence.
A local FD recently won the right to have the Grim Reaper and a skull in flames as accepted tattoos because they did not fit the definition of offensive. Since most of them are Paramedics, patients including kids, are now subjected to tattoos which some terrifying dreams are made of.
Tattoos have also represented ownership of women in other countries and are also a sign of human slavery or trafficking here in the US. The "crown" is just a tattoo of a crown but with a specific meaning to the woman forced to wear it. None of the tattoos are what you would call "offensive" by definition but would definitely mean something to someone who might have been through some form of captivity. The same for Holocaust survivors and their families. What you might perceive to be "not offensive" can have a totally different meaning for someone else or a very different cultural interpretation.
I doubt if any of that will matter to you. But, let's take a more personal view.
I love art and I love fashion. I love being up with the latest. Over the last 40 years since my teen years I have changed my hair style and color dozens of time. Of course when I joined the adult working world I had to be in compliance but I was still able to change it up a lot. I also had all the latest in clothes and shoes. A few piercings (small holes) were also part of the fashion. My love of art led me to paint and repaint the walls of my house many times. I also changed the artwork frequently. Every year I found a new trend in art which I liked. Out with the old and in with the new. But, there was some art which my friends thought was very trendy which I would never put on my walls. I found it "offensive" to my senses even though is did not fit the legal definition of "offensive".
The nice thing is I kept the base canvas, my body, a clean slate for the next fashion or style. I have not done any permanent damage. I can still be creative and artful in appearance without disturbing what I was born with.
I remember being a kid in the 1960s at the circus and saw the "tattooed couple". A man and woman were featured as a freak show. Thinking back, they look like some today. I can guarantee that fashion will change again for tattoos. WWII they were popular for military personnel. After Vietnam they represented baby burners. Tattoos might be the rage today but what about 5 years from now? Will you be an embarrassment to your kids? I see the men still hanging on to wearing long hair since the 1970s. They are looked at like scummy bums by some in EMS, the ED and others in healthcare regardless of their socioeconomic status just because long hair on men is not today's look. Bald is in today. A few years ago that look was considered skin heads and commonly associated with the Aryan nation. That image is still vivid for some.
You might be taking "offensive" at only a superficial level. Live long enough and take lots of selfies to see how your opinion of art might change.
My anecdote was defined as a reminder about past events, it is often proposed to support or demonstrate some point and make readers and listeners laugh. While any professional person jokes regarding other professions( NP/PA/students/fellows/others) that they are less trained/ has loose skills and other "bushtit", NP/CNS are doing clinical research in ]National Institutes of Health (NIH) as Principle Investigators.( just "google" how many nurses are there...wow)
The fact is: physicians lost "control" for prescribing authority." It is not once upon a time" issue. All this only because of too many law suites, management policy changes and high cost to train MD and then to pay for MD/DO treatment.
NPs /CNS are chipper and much better in quality of care, preventative care specially for chronic patients in outpatient settings.
What can we do if patients like us, trust us and prefer to be treated by NP's/ PA's?
Jealousy, that NP's are so successful will not help to patient care.
I had not thought specifically about using anecdotes in my writing. I will from now on. They would work well in both fiction and nonfiction.
I would try my best to not be biased here but what this thread sheds light on is one of the fundamental differences between a PA and an NP from a hiring physician's standpoint. NP's will come from a diverse clinical background not only in terms of educational preparation but in their pre-NP medical knowledge as nurses.
Prelicensure nursing programs (or RN programs) barely go into detail about medical therapeutics. Nursing has had this long held stand that in order to distance itself from medicine as a separate profession, concepts taught in nursing school must be the least identical to medical verbiage, hence the focus on theories of nursing and "caring". Perhaps also a shortcoming of clinical instruction in nursing programs, students are taught to assess patients and report "worrisome" findings to a physician and this is where things can sometimes stop.
Even the act of giving medications to a patient becomes a task of checking vital signs first and asking a physician if it's OK to give that medication without going into detail about the complexity of the patient's clinical picture and the indications for the medication. Unfortunately, this is not going to change due to scope of practice issues and regulatory/legal constraints of being a nurse.
Nurse Practitioner programs hopefully will undo that "nursing mentality" and mold the NP student to think more as a healthcare provider...one who is capable of assessing a patient, using clinical data from labs and diagnostics to tie the assessment with differential diagnoses, and use concepts in medical therapeutics to come up with a treatment plan. This is easier done in PA programs where all students go through a condensed version of medical school. NP programs in contrast, have long been developed into "specialty focused" tracks that do not always align with the realities of the medical fields.
The OP's medical specialty is a perfect example of the disconnect between how training in medicine is done vs how NP programs are set-up. Emergency Medicine broadly treats patients of all ages in the entire spectrum of primary care, urgent care, and emergency/trauma. There is no single NP track that could adequately prepare us in that field from the get go. FNP tracks can limit the students clinical exposure to settings where x-rays are probably not even uploaded and read because of the strict primary care focus mandated by the curriculum.
Acute Care NP programs separate the age groups between adults and peds, and because of the focus on Acute and Critical Care, exposure to urgent care procedures such as those in orthopedics (splints and casts) and OB (pelvic exams) can be missed from the training. We do have combined FNP/ACNP programs now in a few schools that hope to bridge that training gap in the field of Emergency Medicine.
I have been an NP since 2004 and I think we NP's as a collective group have successfully made a difference as providers alongside physicians in various medical specialties. I think what would work best for someone interested in hiring NP's to join their team is to evaluate each candidate on their individual merits due to the variables in backgrounds and training. For instance, in my field of Adult Critical Care, we find that ex-ICU nurses transition to the role much easier than someone who didn't have that background. We also find that those who graduated from Acute Care NP programs and had ICU rotations in school require less training in figuring out what tests to order and looking at chest x-rays and other imaging films.
The take home message for me is that when dealing with a brand new NP, it's best to start with an inventory of what the NP already knows and have some experience on and strengthen that knowledge while remediating on those not touched on or exposed to during NP training. It would require being upfront on the new NP's part of his/her deficiencies and a commitment on the physician part who is willing to provide the training. That would make for a competent and safe NP and a satisfying relationship with physicians who work with them.
Natural News? The Fiscal Times? Really?
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