Yasuo Posted November 17, 2020 Share Posted November 17, 2020 Hey guys! I have a random question as a new grad PA What if you know what the diagnosis is when seeing a patient, but forgot the appropriate diagnostic workup/treatment? What's a professional way to say "I'll be right back" and quickly go look it up on UpToDate or something without sounding dumb? Quote Link to comment Share on other sites More sharing options...
Febrifuge Posted November 17, 2020 Share Posted November 17, 2020 (edited) I am constantly looking stuff up, right there in front of the patient. Have been doing so for 11 years of practice. We even have a big flatscreen LCD on the wall that shows my screen to the patient. It doesnât make you look dumb. Excusing yourself every few minutes like Clark Kent on a college football Saturday looks weird, though. I just click the UpToDate link right there in Epic and say, âhey, so what you have is ____, and the last time I dealt with a case of this, it all turned out great. I just want to check real quick and make sure nobody changed a guideline, or did a study that changes the recommendations.â Then I scan for what I need, and say something like, âokay, itâs still Cipro plus Flagyl,â or âaha, see, when I went to school they were still saying you needed to finish 14 days of treatment, but 7 should be plenty,â or depending on the patient I could crack a joke, like âyeah, okay, former head of the American College of Endocrinology, if thatâs your *opinion* then I guess we can go with that.â  Mostly though, as a new grad you just need to read. Set aside half an hour after dinner 4 days a week, and read up on what you didnât know that day. Donât obsess, and donât berate yourself, but build up your knowledge base because that builds your confidence. And you need both. Edited November 17, 2020 by Febrifuge 2 2 Quote Link to comment Share on other sites More sharing options...
bike mike Posted November 17, 2020 Share Posted November 17, 2020 Did this today as pulmonologist sent patient back to me for continued SOB/hypoxia. LHC with no CAD, echo with normal EF and no VHD. Pulmonary med hasn't figured out what's causing her issues but no one has worked up coccidiomycosis. Now this is not my area of medicine but knew enough that this should be ruled out as it's prevalent in our area. Quick search to see exactly what should be ordered. Patient was happy that I was thinking of things other than cardiac and I was open that this is not my area of expertise. 1 Quote Link to comment Share on other sites More sharing options...
ANESMCR Posted November 17, 2020 Share Posted November 17, 2020 Just say youâre going to go put some orders in and youâll be right back to discuss them. Quote Link to comment Share on other sites More sharing options...
UGoLong Posted November 17, 2020 Share Posted November 17, 2020 I look things up in front of the patient as well and have ever since becoming a PA 14 years ago. When I was young, my doctor used to leave the exam room every now and then. I always assumed it was to see another patient since the office was very busy. One day I had to find a bathroom and saw him in his office, crammed with books, reading something from one of them. We're fortunate to live in a world where a lot of the world's knowledge is accessible from your phone. Having an advocate who is willing to make sure he or she is correct before doing something probably looks better than one who thinks they know (and remember) it all. 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 17, 2020 Moderator Share Posted November 17, 2020 on line up to date, quick things get looked up live right in the exam room, patient never knows I am the first to admit I don't know something and that I will look it up.... never once, not even a little bit, had any pushback from patients.  No one expects us to know it all except ourselves 1 Quote Link to comment Share on other sites More sharing options...
greenmood Posted November 17, 2020 Share Posted November 17, 2020 Look it up in front of the patient. If youâre scared about it, you can do it under the guise of teaching them, and print them the patient-centered materials from UTD. Quote Link to comment Share on other sites More sharing options...
Cideous Posted November 17, 2020 Share Posted November 17, 2020 2 hours ago, greenmood said: Look it up in front of the patient. If youâre scared about it, you can do it under the guise of teaching them, and print them the patient-centered materials from UTD. LOL no offense but I would NEVER do that. Â That's a good way to get a 1 star google review that starts out, "Your never going to guess what this "Assistant" did in front of me!???" 1 Quote Link to comment Share on other sites More sharing options...
thinkertdm Posted November 17, 2020 Share Posted November 17, 2020 Just say youâre going to get a sandwich. Â Or talk to the manager like they do at the car dealership. in reality, I just alt tab to uptodate while making small talk. Â Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted November 17, 2020 Moderator Share Posted November 17, 2020 Iâve looked up plenty of things in front of a patient, sometimes I leave if I think it will take a minute. Sometimes I tell them Iâm doing a risk calculation or I have to double check as I recall there may be some new research on the topic that just came out. Plenty of reasons for it. 1 1 Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted November 17, 2020 Share Posted November 17, 2020 Tell them you need to see a man about a dog. 1 Quote Link to comment Share on other sites More sharing options...
thinkertdm Posted November 17, 2020 Share Posted November 17, 2020 Donât say these to patients (number four will shock you!) 1.  Uh oh 2. whoops! 3.  Can you return my watch with your FIT test 4. Your prostate feels good 5.  CRAP! 6.  Iâve got good news and bad news.  The good news is I saved 5% on my ... As long as you donât use any of those, you are ok. Quote Link to comment Share on other sites More sharing options...
Cideous Posted November 18, 2020 Share Posted November 18, 2020 (edited) 20 hours ago, thinkertdm said: Donât say these to patients (number four will shock you!) 1.  Uh oh 2. whoops! 3.  Can you return my watch with your FIT test 4. Your prostate feels good 5.  CRAP! 6.  Iâve got good news and bad news.  The good news is I saved 5% on my ... As long as you donât use any of those, you are ok. I walked into the procedure room one time in Urgent Care to see a bloody arm wrapped in a shirt.  My MA walked in there with me and when I took off the bandage/shirt there was a large FA lac, which looked impressive but was nothing I couldn't fix.  However, as soon as it was exposed my MA gasp and said in a very loud voice, "Oh my gosh, can you fix that!!??" After I had "the talk" with her, we laughed about it for years.  Edited November 18, 2020 by Cideous Quote Link to comment Share on other sites More sharing options...
greenmood Posted November 20, 2020 Share Posted November 20, 2020 (edited) On 11/17/2020 at 10:50 AM, Cideous said: LOL no offense but I would NEVER do that.  That's a good way to get a 1 star google review that starts out, "Your never going to guess what this "Assistant" did in front of me!???" Iâm not afraid of lack of subspecialty knowledge, or ashamed of learning with my patients. My job as a Hospitalist isnât to know the fourth line treatment for XXX which is already so rare weâve only had three cases in the last year. Thereâs no way for me to be more of an expert in a weird disease than the person whoâs living with it. I donât recommend hemming and hawing over UTD in front of the patient, but saying âletâs double check the MRI guidelines on this one and Iâll send you with some reading before your outpatient follow upâ is an acceptable way of dealing with the OPâs scenario. If youâre good at it, it builds trust with the patient. And you learn something. Iâm not aware of any negative google reviews (7 years). Edited November 20, 2020 by greenmood Quote Link to comment Share on other sites More sharing options...
Cideous Posted November 20, 2020 Share Posted November 20, 2020 2 minutes ago, greenmood said: Iâm not afraid of lack of subspecialty knowledge, or ashamed of learning with my patients. My job as a Hospitalist isnât to know the fourth line treatment for XXX which is already so rare weâve only had three cases in the last year. Thereâs no way for me to be more of an expert in a weird disease than the person whoâs living with it. I donât recommend hemming and hawing over UTD in front of the patient, but saying âletâs double check the MRI guidelines on this one and Iâll send you with some reading before your outpatient follow upâ is an acceptable way of dealing with the OPâs scenario. If youâre good at it, it builds trust with the patient. And you learn something. Iâm not aware of any negative google review (7 years). You're a  hospitalist.  I'm coming from the point of a corporate Urgent Care.  180 degree difference here. Quote Link to comment Share on other sites More sharing options...
Joelseff Posted November 21, 2020 Share Posted November 21, 2020 (edited) 17 hours ago, greenmood said: Iâm not afraid of lack of subspecialty knowledge, or ashamed of learning with my patients. My job as a Hospitalist isnât to know the fourth line treatment for XXX which is already so rare weâve only had three cases in the last year. Thereâs no way for me to be more of an expert in a weird disease than the person whoâs living with it. I donât recommend hemming and hawing over UTD in front of the patient, but saying âletâs double check the MRI guidelines on this one and Iâll send you with some reading before your outpatient follow upâ is an acceptable way of dealing with the OPâs scenario. If youâre good at it, it builds trust with the patient. And you learn something. Iâm not aware of any negative google reviews (7 years). I got no shame either in saying "I don't know but let me find out." been practicing only 10 years (mostly Primary care and HIV, did 2 years in GI, moonlit in UC for a year and 6 mos in PM&R) but in that ten years my yelp and Google scores are near 5 stars (some have complained about our billing dept and knocked me down to 4.8 ) press ganeys are high 90s and at my last primary care job at a hospital based IPA setting I was ranked 5 out of 66 ambulatory care providers (Docs and APPs... only APP in the top 20) so if it's detrimental to say "I don't know" or "let me check on that" it hasn't affected me or how my Patients perceive my care... Yet  Edited November 21, 2020 by Joelseff Quote Link to comment Share on other sites More sharing options...
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