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Cardiology, Research, Family Practice
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GoodNP specializes in Cardiology, Research, Family Practice.

GoodNP's Latest Activity

  1. GoodNP

    Has anyone left nursing job due to COVID19 virus?

    To those whose hospitals say they are not allowed to wear masks: Wear one anyway, even if you have to furnish your own. If you are disciplined/fired/whatever, call the news. And a lawyer. Perhaps I'm naive, but I believe that very soon we will have an abundance of masks and other PPE. By then, most of the entire country will have been exposed so the point may be moot anyway. BUT! We will never forget! Our hospitals do not care about us. We already knew it, and they just proved it. That is the inarguable truth. Assuming we all have been or will be exposed, I am preparing myself for the inevitability that I will get the virus. But I believe I am healthy enough that I will be OK. If you feel otherwise about your health, then I recommend staying home.
  2. Amen to this. I'm sick of the uber-wealthy preaching at us in general, but especially right now. A few have made donations - but at such a tiny percentage of their net worth. There are billionaires out there. Why aren't they paying for masks and vents to be made? I've heard people mention nurses and our "social contract". What about the social contract for those who became wealthy off of ordinary people buying your iphones, or watching your talk shows/subscribing to your magazines, buying your vagina-scented candles, etc.? Take one for the team!
  3. not to mention the number of false negatives, considering rapid flu tests have a sensitivity varying between 10%-80%
  4. I wish I had adequate PPE. The death rate in my age group is 0.25%. If I had no mask at all, I would willingly strap on a bandana and take care of a patient who would likely otherwise die.
  5. If you are referring to yourself, please do not come back from retirement unless you're going to work phone triage or something like that. You have done your part and we thank you eternally.
  6. GoodNP

    Considering Quitting my Job

    The point I was trying to make is that in the beginning, PPE shouldn't have been treated as if they were neverending breadsticks at Olive Garden.
  7. GoodNP

    NP's how are you these days?

    Yes, the medical assistants are now being offered positions in drive through testing sites. Volume improved some today. We still have people with COPD exacerbations, or extremely high blood sugar, blood pressure, chest pain, abscesses, etc. And, in order to get covid testing here, patients must first have a negative strep and flu test. So we're not back up to full speed, but getting better. Front desk staff still at risk though because of so many virtual visits. Sigh.
  8. GoodNP

    Considering Quitting my Job

    Agreed. Who knows how comparable this is to covid19, but for influenza aerosols surgical masks not inferior to n95: https://www.sciencedaily.com/releases/2019/09/190903134732.htm Also, I've been thinking the one time use and disposal of these supplies is unnecessary and extremely wasteful. Sure there are "best practices", but isn't there also a time for "good enough practices"? How many respirators and masks would we have today if we were being a little more frugal from the beginning. Going through 6 months of supplies in one week? Initially I was angry with my clinic for not providing more masks to us. However, when there are no masks, what are they supposed to do? The government and private companies are working to manufacture supplies for PPE and testing. We'll have what need very soon.
  9. GoodNP

    Wellness meets COVID-19

    A refreshing and empowering perspective! Can't change your genes or stop time, but you CAN exercise (probably), lose weight, not smoke, etc.
  10. GoodNP

    NP's how are you these days?

    Another primary care update: No patients. Went from seeing 22-25/day down to 10 (2 in person, 8 virtual visits). Hospital owned group is laying off half the clinic in the next few days.
  11. GoodNP

    NP's how are you these days?

    primary care here - not sure about my colleagues, but I, too, am not initiating prescriptions for ACE's. Still giving ARBs as I haven't seen them specifically called out in the literature, and besides there's no lung conversion (same reason they don't cause cough, right?). Also, giving far fewer corticosteroids. Did my first telemedicine visit on Friday for med refills. Suspect this will become the new norm. Not sure I like it. Oh yeah, still re-using the same surgical mask which I had to provide for myself.
  12. GoodNP

    NP's how are you these days?

    Primary care: Lots of patients with cough, some shortness of breath here and there, but few with fever. Only one patient that I had a high level of suspicion due to domestic travel to an area with increasing prevalence reported. Since she's afebrile, stable, and low-risk, didn't send her for testing. My problem - 24 staff:5 N95 respirators AND a CMO belittling those of us wearing surgical masks. Actually had a staff meeting and told us that wearing a surgical mask increases inhaled virus. I'm wearing mine anyway.
  13. GoodNP

    HUGE step forward for NP's!!!

    It seems to me like a win-win considering most NP/PAs are employed by physicians or physician groups anyway. Whether a privately owned practice or a large corporation such as HCA, the revenue generated by NPs and PAs directly affects physicians' incomes. If some providers are bringing in 15% less than others, why wouldn't all shareholders be in favor of leveling that disparity? And incident to billing is actually quite tricky in family or internal medicine because established patients are constantly coming in with a variety of new issues. Regarding kudzui's comment above: it has been my observation that family physicians are so overwhelmed with patients they quickly refer out any patient that takes a little bit of extra work. One or two visits for a given issue, if not resolved then refer out. there are also health care conglomerates that encourage their providers to consider early referral to specialists within that "network". In these cases it's not only approved of, it is encouraged, because of the higher reimbursement rate afforded to specialists. finally, with quality measures such as MIPPS, many primary care providers including physicians will continue to refer out patients who would otherwise be managed in primary care but adversely affect their numbers, such as diabetics with a1c >9.0. Passing the buck so to speak. as to your point about patients wanting to see physicians - I think you are right. While all of us have plenty of patients who prefer to see us over the physician, I think the majority of patients would probably still prefer to see the physician particularly for complicated issues. It is understandable, and we shouldn't take issue with that.
  14. GoodNP

    HUGE step forward for NP's!!!

  15. GoodNP

    HUGE step forward for NP's!!!

    Many great points in this thread. I definitely agree that physician education and training is superior to NPs'. It always astounds (read: embarrasses) me when NPs or PAs compare themselves on equal footing as physicians. Then again, I'm not pursuing independent practice. I know my limitations. However, there is an imbalance in the amount and often, dare I say, quality of actual work performed. I follow guidelines, perhaps a little too cookbook-y at times, but whereas my physician peers are throwing a z-pack at every URI that walks in the door, I'm only giving antibiotics when they are actually indicated, and then I'm preferentially giving amox-clav. Whereas the physicians don't document PMH, PSH, fam hx, etc, I do. It's never fun when you see an established patient and they casually reference their kidney transplantation which has never been documented in the chart of years of being seen at this clinic. My physician peers also aren't diligent about preventive care screenings. They're not ordering enhanced imaging or genetic testing for women at high risk for breast cancer (nor would they even know bc they don't ask about family history), no lung cancer screening CTs, they're not following pap guidelines, not recommending HPV vaccines, no hep C screening, no PPSV for diabetics, no AAA screenings for smoking history. I am so diligent about these low hanging fruits and make sure it is ALL done. When I look at their documentation I can't help but roll my eyes. I refuse to believe they are performing fundoscopic exams on all of their PEs. Last month I found a rather large thyroid mass during a PE, turned out to be cancer, and the patient later told me in all the years she has been seen by Dr. X he had never checked her thyroid. Oh, but he's doing fundoscopic exams? Please. And yet, I get paid 15% less, for doing more. I concede that they are better qualified to handle more complicated cases, but I would bet a paycheck that NPs actually perform better than physicians on preventive care. Which is supposed to be our wheelhouse right? So, with such a push for preventive care, I think that at a minimum we should be fully reimbursed for those services.
  16. GoodNP

    Are Braids Professional?

    They look clean and neat, to me that looks professional. Only thing is when you're bending down for example, it seems your hair would fall into the workspace and/or other people's personal space. But that would be the case for anyone with long hair regardless of texture and with or without braids. So pull it back when you're at work and voila! (a little jealous here of your beautiful hair)

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