NYT article

[deleted6669]

Good for you. I still wont be "supervising" any midlevel, NP or PA.

Here's another example of emedpa's double tongue:

http://www.physicianassistantforum.com/forums/showthread.php/35742-You-handle-the-easy-ones...

Paula: P.S. Yup, we need to be physician associates and out from under.
Emedpa: it's a work in progress....

I can play this game all day long.

"it's a work in progress" was in response to what is going on with the name change movement not anything to do with independence. I am for pa's working with docs as can be seen from my multiple postings here and elsewhere.

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[deleted6669]

Here's another emedpa quote that shows his true colors:

http://www.physicianassistantforum..../35528-Creating-a-Sub-specialty-Certification

This thread is in reference to subspecialty certification for PAs.

Emedpa: "I agree but wouldn't be even more important if we were independent like np's? we would need an objective criteria to say we were specialists in our given field, right?"

once again quoted out of context. read the whole discussion I was playing devil's advocate. are you my personal stalker or something? get a life dude.

 

[Socrates25]

Wow this is a lot of fun watching you squirm!

Here's some more of emedpa's greatest hits:


http://www.physicianassistantforum....-to-med-school?p=323554&highlight=#post323554

emedpa: easy solution. never say "assistant" again. say "hi, I'm febrifuge, one of the pa's here today".
"what's a pa?"
"well I have a 4 yr degree in xyz then I spent xyz time as an er tech then I did a 2 yr graduate program in medicine with rotations in xyz."
"oh, so like a doctor."
"yeah, like that."


Yeah, you're not trying to mislead anybody at all. You're a doc's best friend arent you? Funny how you never post any of that stuff on SDN. I wonder why that is?

 

[deleted6669]

listen genius, that's about name change(which I believe in) not independence(which I don't).
you really are an *****clown.

 

[Socrates25]

listen genius, that's about name change(which I believe in) not independence(which I don't).
you really are an *****clown.

Tsk tsk tsk.... watch out for those personal insults guy. We wouldnt want to get you banned, you are great comedic relief around here!

 

[deleted6669]

Tsk tsk tsk.... watch out for those personal insults guy. We wouldnt want to get you banned, you are great comedic relief around here!

it's impossible to get banned around here. I have "nominated" you for that honor several times. no one deserves it more. you are a troll, plain and simple. you use every post to berate pa's, np's, medical students, and anyone else you don't agree with. that is the definition of trollish behavior. mods, if you ban me, please take a minute and review socrates posts and ban him as well.

 

[Socrates25]

it's impossible to get banned around here. I have "nominated" you for that honor several times. no one deserves it more. you are a troll, plain and simple. you use every post to berate pa's, np's, medical students, and anyone else you don't agree with. that is the definition of trollish behavior. mods, if you ban me, please take a minute and review socrates posts and ban him as well.

Well I'm sure this thread is going to be locked at any moment by a moderator, so before that happens let me just say it was a real pleasure working with you, sir.

And you are right about one thing -- I definitely dont trust midlevels (and no, I refuse to call you a physician associate). Everybody on this forum knows that. And everybody knows where I stand. I have been nothing, if not absolutely consistent on that point.

You, on the other hand, like to play games where you pretend to play nice with the doctors on SDN while clearly revealing your hidden agenda on other forums. Clearly it has worked well for you. You've ingratiated yourself as a "regular" on the EM forum.

I'll make you a deal. If you stop telling lies about me, I'll stop telling the truth about you.

(bonus points for whoever gets that reference.)

 

[Rendar5]

Thank you for completely derailing the thread socrates. (although it did need a good de-railing)

 

[deleted6669]

I'll make you a deal. If you stop telling lies about me, I'll stop telling the truth about you.
QUOTE]
HOW ABOUT YOU NEVER GO TO THE PA FORUM AGAIN AND STOP STALKING ME HERE AND I WON'T RESPOND TO ANY OF YOUR POSTS UNLESS YOU ARE EXTRA INSULTING?

 

[8654Marine]

Interesting.

 

[alreadylernd]

I'll make you a deal. If you stop telling lies about me, I'll stop telling the truth about you.

(bonus points for whoever gets that reference.)

Adlai Stevenson - political quote.

 

[docB]

We've strayed off topic as the initial subject had nothing to do with midlevels. So lets stay civil and get back on topic.

 

[mmmmd]

WARNING: premed here, i am ignorant and i know nothing about medicine!

In closing, I wish we could focus more on how to truly make the system better rather than argue with each other, focus on where to assign blame, or decide whom to punish. There is a difference.

This is what I seek to address.

My money regarding the mottling is that the patient never got undressed for the exam. It's somewhat difficult to dismiss mottling if you actually see it. Then my mind goes back to how many people I saw today that were undressed and in gowns (~3/21).

I'm curious if the docs on this board think that if the ER docs at NYU were made more aware of the mottled skin, might that have lead to better outcome?

Until we reform the medical malpractice system (and really the tort system as a whole) we will not have anyone who is willing to go out on a limb and risk losing everything to try to correct systems problems. Because our system creates incentives to make grave allegations and try to move blame to the deepest pockets rather than the truly culpable no one is concerned with fixing the system, only with dodging the bullets or making the $$$.

The best thing we could do is to separate the punishment and compensation functions that are currently both served by the perversion of the current system.

This quote goes waaaaay above my head, but I am definitely interested to learn more if someone has a link or two to send my way. I think reform is happening right now in many ways.

In particular, I think that if we had truly interoperable EHRs, the mottled skin in this case might have been a prominent factor in saving the pt. The article says that "Hospital records do not reflect any communication with Dr. Levitzky or her findings about the mottled skin." So basically, the referral from pediatrics to emergency took the form of: "mom and dad, take your son to the ER." There was no mention of communication between doctors during this transfer of care, and thus the pediatrician's report has the documented mottled skin finding, while the ER docs missed it. I think this lack of communication is a systematic issue in continuity of care, and I think it can be fixed. The systematic repair is hopefully already under way with all the gov't funding being poured into developing functional EHR systems thru the ONC.

 

[Apollyon]

I'm curious if the docs on this board think that if the ER docs at NYU were made more aware of the mottled skin, might that have lead to better outcome?

If I get bored, my hand mottle. The veins on the dorsum (back) of my hands also distend (swell). I don't have sepsis, or, if I do, I am a near superman, as I am not dead.

It's a nonspecific sign, and, as I said, this was a needle in a pile of needles.

 

[deleted109597]

This quote goes waaaaay above my head, but I am definitely interested to learn more if someone has a link or two to send my way. I think reform is happening right now in many ways.

Not really. At least not the kind he is talking about.

The systematic repair is hopefully already under way with all the gov't funding being poured into developing functional EHR systems thru the ONC.

Money isn't being poured into it by the government. Private groups are pouring money into "meaningful EMR" because they're being forced to. Done right, EMR can help. But when every clinic in town has a different EMR, and they don't communicate, it is pretty useless.

 

[docB]

In particular, I think that if we had truly interoperable EHRs, the mottled skin in this case might have been a prominent factor in saving the pt. The article says that "Hospital records do not reflect any communication with Dr. Levitzky or her findings about the mottled skin." So basically, the referral from pediatrics to emergency took the form of: "mom and dad, take your son to the ER." There was no mention of communication between doctors during this transfer of care, and thus the pediatrician's report has the documented mottled skin finding, while the ER docs missed it. I think this lack of communication is a systematic issue in continuity of care, and I think it can be fixed. The systematic repair is hopefully already under way with all the gov't funding being poured into developing functional EHR systems thru the ONC.

EHRs had the potential to make information more available but in the reality that many of us are living it's just not the case. Both of the EHRs that I use right now bury details in mountains of verbiage in an attempt to make the notes read more like a longwinded dictation and they incorporate a lot of extraneous regulatory hoop information like if the person in abused at home or not.

 

[WilcoWorld]

Money isn't being poured into it by the government. Private groups are pouring money into "meaningful EMR" because they're being forced to. Done right, EMR can help. But when every clinic in town has a different EMR, and they don't communicate, it is pretty useless.

Furthermore, the info in EMR is mostly useless. In order to see mottled skin mentioned in an EMR you'll have to sift through several pages of nursing notes documenting that the bowel sounds are present, the pain is an 8, the side rails are up, that the lab was ordered, the sample was drawn, the lab was resulted, the physician was notified...

EMR is a great idea, but it's execution has in many cases made information harder to access than it was with paper charts.

 

[gutonc]

Furthermore, the info in EMR is mostly useless. In order to see mottled skin mentioned in an EMR you'll have to sift through several pages of nursing notes documenting that the bowel sounds are present, the pain is an 8, the side rails are up, that the lab was ordered, the sample was drawn, the lab was resulted, the physician was notified...

EMR is a great idea, but it's execution has in many cases made information harder to access than it was with paper charts.

No arguing this. But the one we use (Epic, which has many other problems) does allow you to sort by the category of note writer or the note type so you can just bury the nursing notes and read only those from physicians.

 

[WilcoWorld]

No arguing this. But the one we use (Epic, which has many other problems) does allow you to sort by the category of note writer or the note type so you can just bury the nursing notes and read only those from physicians.

Agreed, Epic is better than most.

 

[PTPoeny]

Not really. At least not the kind he is talking about.


Money isn't being poured into it by the government. Private groups are pouring money into "meaningful EMR" because they're being forced to. Done right, EMR can help. But when every clinic in town has a different EMR, and they don't communicate, it is pretty useless.

It would be nice if it were only every clinic that has a different EMR. I have now rotated through several hospitals where L&D and the ER each have a separate EMR that don't interact with the general hospital EMR (or each other). Sometimes a separate peds EMR too.