PACmatthew

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15+ Year Member
Feb 28, 2002
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houston
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Today was my last official day as a PA. Tomorrow I move out of my 2600 square foot beauty and drive 4 hours in a 26 foot UHAUL to my new 1100 square foot dump.

I had a horrible patient outcome on my last day; one that has driven me to unpack some of my kitchen boxes to find the Chivas Regal. I had a lady who came to me exactly a year ago at age 49 for a well woman exam. She had only one compaint, and that was of severe vaginal dryness. Her pap showed obvious atrophic changes and we discussed HRT. She had no family history of breast CA, but she had a huge family history of heart disease. After discussing it with her, I gave her a month of FemHrt and sent her out for her mammogram. The next month I got a phone call that she was doing great on the FemHrt and that she needed a mail-in script to send away for a 3 month script to save money. She said she had her mammo scheduled and she would have it done in the next week. At the 6 month mark, she called and asked for another refill but I told her I needed her mammo first. She still had not gone to have it done. She absolutely promised to get it done the next week but she wanted another mail-in script to save money. To be nice, I again wrote 3 months, and then my doc refilled it three months later when she again called without having done her mammo. I had been out and my doc just gave it to her because she gave him the same speech about not having time to get the mammo. Today, I got a call from the Breast Center where I sent her, and it seems she had an abnormal mammo. She had already been called by them, and they had done a biopsy, and Abd, Pelv/Chest CT. She had mets all over. This is the perfect example of how if we were just simply strict, mean, non-negotiable in our stance about not giving her the script, she might have had this found earlier. The flip side is that if you practice medicine in a way that is militaristic and place deadlines on patients, they often go elsewhere. She new the risks, and was told every time. Everyone loses in this situation, and it sucks.
 

efs

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15+ Year Member
Jul 20, 2001
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Germany
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  1. Podiatrist
Sorry to hear about the bad outcome. These types of things will happen though. A question for you. At what level do you place personal responsibility on the patient. Sounds like you had made her aware of the importance of having the mammogram. She should have at least been aware of some of the risk she was taking on in postponing her tests and appointments. We cannot be personally responsible for the actions of all of our patients. Just can't happen.

On another note. Glad to hear that you are moving on. Good luck in school. Hope things work out well for you.
 
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