It's official: Physician Associate (not Assistant).

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Wordead said:
But Im saying it guides you. Yes it's not 100% even in an expert's hands but a history is definitely not definitive in the least as much as UWORLD makes you think that. For example, take "ear pain". Extremely common primary care or ED complaint. You know how many I see on a weekly basis? Treated with multiple courses of antibiotics for "ear infection"? Dozens. You know how many actually have an ear infection? Like 5%. All it would take to save these patients multiple trips, multiple courses of antibiotics, random other medications, would be the referring person having any idea of what a normal ear looks like. That's it. It's ALWAYS documented "bulging erythematous TM" or some nonsense. Ill see them a day later or same day and it's invariably pristine.

Other examples - "nasal polyps" = turbinate. "lymphadenopathy" = submandibular gland. Coming in with CTs and some treatment for normal exam findings. All the time. Waste of everyone's time and money.
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Wait i thought it was already clear ear exams are useful?
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Lawpy said:
Wait i thought it was already clear ear exams are useful?
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The turbinates are part of the nose
the submandibular glands are part of the neck

and this is just in my field Im sure urology / ortho / whatever could come up with their own examples. But these are complaints fielded by primary care doctors that then inappropriately refer.
 
Wordead said:
The turbinates are part of the nose
the submandibular glands are part of the neck

and this is just in my field Im sure urology / ortho / whatever could come up with their own examples. But these are complaints fielded by primary care doctors that then inappropriately refer.
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Right, i was looking at your ear example initially

I mean even the neuro guys would agree a physical exam is important especially in emergent conditions rather than waiting for CTs/MRIs. I don't have an opinion on this either way but i did see from my experience the PCPs tried to do physical exams as best as they can and highly valued them.
 
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Lawpy said:
Right, i was looking at your ear example initially

I mean even the neuro guys would agree a physical exam is important especially in emergent conditions rather than waiting for CTs/MRIs. I don't have an opinion on this either way but i did see from my experience the PCPs tried to do physical exams as best as they can and highly valued them.
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Right but as you can see from this thread that a huge chunk of med students think it's a useless skill.
 
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Matthew9Thirtyfive said:
What’d he say?
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He said he had heard of it before when it was discussed in his department and other respiratory therapists tried to say “oh you’d be able to prescribe medications!” He said that he didn’t understand what their purpose even was and that if he wanted to get a graduate degree he would do like anesthesiology assistant (it’s unlikely he does any).
 
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Wordead said:
But Im saying it guides you. Yes it's not 100% even in an expert's hands but a history is definitely not definitive in the least as much as UWORLD makes you think that. For example, take "ear pain". Extremely common primary care or ED complaint. You know how many I see on a weekly basis? Treated with multiple courses of antibiotics for "ear infection"? Dozens. You know how many actually have an ear infection? Like 5%. All it would take to save these patients multiple trips, multiple courses of antibiotics, random other medications, would be the referring person having any idea of what a normal ear looks like. That's it. It's ALWAYS documented "bulging erythematous TM" or some nonsense. Ill see them a day later or same day and it's invariably pristine.

Other examples - "nasal polyps" = turbinate. "lymphadenopathy" = submandibular gland. Coming in with CTs and some treatment for normal exam findings. All the time. Waste of everyone's time and money.
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I mean you’re literally arguing my point. The examples your giving are both ENT exams that fall under the small subset of times it would be useful.
 
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Wordead said:
The turbinates are part of the nose
the submandibular glands are part of the neck

and this is just in my field Im sure urology / ortho / whatever could come up with their own examples. But these are complaints fielded by primary care doctors that then inappropriately refer.
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Those are literally the examples I used when I said the physical exam is useful sometimes.
 
Matthew9Thirtyfive said:
I mean you’re literally arguing my point. The examples your giving are both ENT exams that fall under the small subset of times it would be useful.
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I have a hard time believing that my field is literally the only one where the physical exam is important. And if it is, why is everyone still so bad at it? If everything else can be neglected?
 
Wordead said:
I have a hard time believing that my field is literally the only one where the physical exam is important. And if it is, why is everyone still so bad at it? If everything else can be neglected?
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You're a specialist, of course everyone else isn't as good as you are at the exams of your specialty...
 
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VA Hopeful Dr said:
You're a specialist, of course everyone else isn't as good as you are at the exams of your specialty...
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That wasn't my point. More that I think the physical exam should be still emphasized head to toe and I dont believe it's not important in any specialty except mine.
 
Wordead said:
That wasn't my point. More that I think the physical exam should be still emphasized head to toe and I dont believe it's not important in any specialty except mine.
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Physicians blatantly ignoring test characteristics and evidence because of “feelings” is why it takes a decade for practices to change.
 
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VA Hopeful Dr said:
You're a specialist, of course everyone else isn't as good as you are at the exams of your specialty...
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I thought wordead just wants PCPs to know what a normal ENT findings look like to avoid overtreating/overdiagnosing normal findings and unnecessary referrals

Although i'm having a hard time believing a PCP attending is bad at ENT physical exam. The midlevels are complete trash though
 
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sunshinefl said:
Me texting this to my RRT husband:

View attachment 337958
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Are there are professions out there that don't want to be advanced? What happened to nurses who just want to be excellent nurses? (apply that to any field) If you want to drive care, that's called a doctor. Become one if you're interested.
 
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Lawpy said:
I thought wordead just wants PCPs to know what a normal ENT findings look like to avoid overtreating/overdiagnosing normal findings and unnecessary referrals

Although i'm having a hard time believing a PCP attending is bad at ENT physical exam. The midlevels are complete trash though
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It's not that hard to imagine. At my school, the ENT physical exam day (we had one day of Physical Dx in second year) was not covered for some administrative change. In medical school, I just watched others go through the motions. I've seen Bates a few times, but no one's formally told me to look in a year, ask me what I say, and tell me I'm right or wrong. That's a problem with the education sometimes. Attendings sometimes like to say..."hmmm, that's interesting"...my exam was slightly different instead of "hey of no you dumb***, that's not a bulging tympanic membrane". In IM residency, a girl was having ear pain and asked one of her colleagues to look in her ear. When she asked what he saw, he wasn't sure. He said he hadn't looked in an ear since medical school. I thought back, I personally had looked on physical exam at times, but never actually come with someone with full blown otitis media.

Tl;dr: you'd be surprised.
 
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sunshinefl said:
Yes, exactly!
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The same applies to doctors too IMO. People aren't satisfied with just coming in, doing good work, and coming out. Then they're just the same as everyone else. They want to brand themselves on social media, start bad business ventures, etc.
 
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Redpancreas said:
It's not that hard to imagine. At my school, the ENT physical exam day (we had one day of Physical Dx in second year) was not covered for some administrative change. In medical school, I just watched others go through the motions. I've seen Bates a few times, but no one's formally told me to look in a year, ask me what I say, and tell me I'm right or wrong. That's a problem with the education sometimes. Attendings sometimes like to say..."hmmm, that's interesting"...my exam was slightly different instead of "hey of no you dumb***, that's not a bulging tympanic membrane". In IM residency, a girl was having ear pain and asked one of her colleagues to look in her ear. When she asked what he saw, he wasn't sure. He said he hadn't looked in an ear since medical school. I thought back, I personally had looked on physical exam at times, but never actually come with someone with full blown otitis media.

Tl;dr: you'd be surprised.
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We had a whole lab session during our clerkship boot camp on otoscopy with an ear simulator that had like 10 different cases we had to do, describing our findings, our diagnosis, and treatment.
 
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Redpancreas said:
It's not that hard to imagine. At my school, the ENT physical exam day (we had one day of Physical Dx in second year) was not covered for some administrative change. In medical school, I just watched others go through the motions. I've seen Bates a few times, but no one's formally told me to look in a year, ask me what I say, and tell me I'm right or wrong. That's a problem with the education sometimes. Attendings sometimes like to say..."hmmm, that's interesting"...my exam was slightly different instead of "hey of no you dumb***, that's not a bulging tympanic membrane". In IM residency, a girl was having ear pain and asked one of her colleagues to look in her ear. When she asked what he saw, he wasn't sure. He said he hadn't looked in an ear since medical school. I thought back, I personally had looked on physical exam at times, but never actually come with someone with full blown otitis media.

Tl;dr: you'd be surprised.
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I think part of the problem is that when we learn the physical exam, we are only seeing “normal” on each other. So we don’t get to see what a lot of findings look like.
 
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Redpancreas said:
Nice man.
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Yeah it was super cool. It was like a silicon ear with a screen inside where the TM would be and you could select which case to do (it was just numbered so you didn’t know what it was prior to doing it). So you had to really practice the technique because if you weren’t then you wouldn’t see what you needed to see. The only thing you couldn’t do was test the mobility.
 
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Redpancreas said:
The same applies to doctors too IMO. People aren't satisfied with just coming in, doing good work, and coming out. Then they're just the same as everyone else. They want to brand themselves on social media, start bad business ventures, etc.
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Oh yeah this is awful too. But I don’t think it’s many, I think it’s just the minority. The biggest social media med student personality in my class failed out by the end of M1.
 
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sunshinefl said:
Oh yeah this is awful too. But I don’t think it’s many, I think it’s just the minority. The biggest social media med student personality in my class failed out by the end of M1.
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None of the aspiring influencers in the class below mine were still on social media by the end of M1. My class didn’t have any like that thank God.
 
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Matthew9Thirtyfive said:
Physicians blatantly ignoring test characteristics and evidence because of “feelings” is why it takes a decade for practices to change.
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Med students being unwilling to master skills fundamental to being a physician because they find it useless is why PAs and NPs can claim equivalence.

Look I can do it too
 
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Wordead said:
Med students being unwilling to master skills fundamental to being a physician because they find it useless is why PAs and NPs can claim equivalence.

Look I can do it too
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Except your argument is a strawman, since I never made the argument that we shouldn’t learn how to do a physical exam or that a physical exam should be totally thrown out. In fact, I argued the opposite and stated that the exact examples you gave were just the type of situation the physical is useful for. If you’d like to argue my point that the physical exam doesn’t add much in the majority of cases, please do. But preferably in a different thread, since it’s not really the point of this one.
 
Matthew9Thirtyfive said:
Except your argument is a strawman, since I never made the argument that we shouldn’t learn how to do a physical exam or that a physical exam should be totally thrown out. In fact, I argued the opposite and stated that the exact examples you gave were just the type of situation the physical is useful for. If you’d like to argue my point that the physical exam doesn’t add much in the majority of cases, please do. But preferably in a different thread, since it’s not really the point of this one.
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Sure Ill admit I have no idea who said what and I dont tend to go back and pick apart posts so perhaps you weren't the one. But others in this thread have certainly said that - and Ive seen that same sentiment in plenty of other SDN threads as Im sure you have.
 
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Wordead said:
That wasn't my point. More that I think the physical exam should be still emphasized head to toe and I dont believe it's not important in any specialty except mine.
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Learning how to do a thorough physical exam is absolutely something that should be (and I hope is) still emphasized.

However, once you're reasonably proficient in it its important to understand the limitations of exam findings (which in much of my day to day practice are considerable).
 
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VA Hopeful Dr said:
Learning how to do a thorough physical exam is absolutely something that should be (and I hope is) still emphasized.

However, once you're reasonably proficient in it its important to understand the limitations of exam findings (which in much of my day to day practice are considerable).
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This. It was some combination of me and Jhh whatever his name is that triggered this, but I wasn't arguing not to teach it. Just that in actual practice in the real world it has extremely limited utility for many physicians, and when it does have utility it is usually to answer an extremely specific question, not to screen.
 
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Lem0nz said:
This. It was some combination of me and Jhh whatever his name is that triggered this, but I wasn't arguing not to teach it. Just that in actual practice in the real world it has extremely limited utility for many physicians, and when it does have utility it is usually to answer an extremely specific question, not to screen.
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And in a majority of situations, at least in my experience, if the PE doesn’t confirm something but the history is strongly suggestive, we usually just assumed the PE was not reliable.
 
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I haven't spoken with any PAs about this name change, but nearly every resident and attending I've spoken with have rolled their eyes at the sheer absurdity of this. Nice to know I'm not alone at work.
 
curbsideconsult said:
I haven't spoken with any PAs about this name change, but nearly every resident and attending I've spoken with have rolled their eyes at the sheer absurdity of this. Nice to know I'm not alone at work.
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The PA student I was just on with last rotation was trying to say it’s good because “assistant” didn’t accurately define their role. I was like uh what?
 
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Matthew9Thirtyfive said:
Yeah. I was like why is it not accurate? And then he started on some bull**** and I tuned out. I was like why is the AAPA spending $21 million to make themselves seem more like physicians?
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Kids like him are the most dangerous and worst PAs. He would be a complete waste of money to hire because you couldn't trust him to do intern-level work. I'm so sick of this everyone-gets-a-trophy mentality.
 
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curbsideconsult said:
Kids like him are the most dangerous and worst PAs. He would be a complete waste of money to hire because you couldn't trust him to do intern-level work. I'm so sick of this everyone-gets-a-trophy mentality.
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Yeah I dunno. He said he wants to do EM because he can be pretty independent in EM, which kind of scared me.
 
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I was sooooo proud of myself recently! That was before the name change. I assisted a PA who assisted a surgeon in the ED. That makes me... a Physician's Assistant's Assistant.
 
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A-Fib said:
I was sooooo proud of myself recently! That was before the name change. I assisted a PA who assisted a surgeon in the ED. That makes me... a Physician's Assistant's Assistant.
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Physician associate associate. There's no " 's". It grinds their gears when people add " 's". A lot of them make it clear that they don't belong to anybody (which they technically don't). They work under doctors' insurance though so maybe they do?
 
Ms Procrastinator said:
Physician associate associate. There's no " 's". It grinds their gears when people add " 's". A lot of them make it clear that they don't belong to anybody (which they technically don't). They work under doctors' insurance though so maybe they do?
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Lolz. Why do you think I added the 's'? lolz
 
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Have you noticed that a lot of PAs introduce themselves as "PAs"? Not "physician assistant" beforehand. Or is this something I've uniquely experienced? Seems like they're boasting about something so dumb, as their title remains to be "PA" still. Needs an ego check imo lmao
 
bigdbron said:
Have you noticed that a lot of PAs introduce themselves as "PAs"? Not "physician assistant" beforehand. Or is this something I've uniquely experienced? Seems like they're boasting about something so dumb, as their title remains to be "PA" still. Needs an ego check imo lmao
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People who don't care will keep introducing themselves as PA. People who need the ego boost will say Physician Associate
 
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bigdbron said:
Have you noticed that a lot of PAs introduce themselves as "PAs"? Not "physician assistant" beforehand. Or is this something I've uniquely experienced? Seems like they're boasting about something so dumb, as their title remains to be "PA" still. Needs an ego check imo lmao
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They had a big propaganda thing going for a bit saying “it’s just PA” to try and obfuscate by pretending assistant wasn’t part of their name.
 
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Lawpy said:
I'm just thinking what's stopping us from replacing midlevels with unmatched IMGs. Because i think a lot of countries have this model from earlier discussions
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cost
 
Ms Procrastinator said:
People who don't care will keep introducing themselves as PA. People who need the ego boost will say Physician Associate
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And then I will promptly correct them until state delegation says otherwise.

PA to doctor relationship is no different than PTA to DPT relationship. Let's starts calling them "physical therapist associate" and see how that blows over.
 
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NY_Premed said:
And then I will promptly correct them until state delegation says otherwise.

PA to doctor relationship is no different than PTA to DPT relationship. Let's starts calling them "physical therapist associate" and see how that blows over.
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Only in medicine do we let ourselves be walked all over. And then have members of our own profession shame us for trying to stand up.
 
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Matthew9Thirtyfive said:
Only in medicine do we let ourselves be walked all over. And then have members of our own profession shame us for trying to stand up.
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Because many among us think we are the best thing that ever happened since sliced bread.
 
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