Would you ask a PA for help?

[eddoc03]

I'm sure the Neurology PA who's been working for 20 years has little to impart on an intern or junior resident

Medicine is just knowledge. If you take the time to learn the material, read the current literature, and have extensive experience, it really doesn't matter what your formal degree is.

A wise person once said "there's nothing a smart person can't learn." Presuming that learning stops just because you're a PA is just dumb. To fail to take advantage of someone's experience and potentially superior knowledge is equally dumb. I know where the buck stops and I don't hesitate to make the tough decision but I'll be damned if I'm going to limit useful information from someone on the basis of their degree.

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[Rendar5]

Let me guess, you go to one of those EM "residencies" where PAs run the show solo with no attending support -- the kind of "residency" that emedpa works at, right? How does it feel presenting all of your patients to the PA?

Does he approve your treatment plans very often? Do the PAs let you do any procedures? LMAO

wow, your dickish comments are really impressive. You're totally right and I now see the light. IN fact, let me get rid of PA's just like you said because I should only discuss cases with the attending. In fact, I'm gonna propose that we get rid of senior residents too since I also ask them for advice occasionally on how to perform a procedure or deal with an issue prior to presenting to the attending. They're just too low on the totem pole to go to for advice.

 

[bulgethetwine]

a) I'm not saying they have nothing to impart. I'm just saying it's surprisingly little.

b) I'd rather get my info from another resident or attending.

Sorry I'm ruining your "let's hold hands around the campfire" mood, dude.

Hahahahahaha Kumbaya - my lord -.... KUMBAYA!

Why go to medical school, do the time, do the residnecy, do the fellowship....

when you can just wait for hte government to sell out all the doctors and replace them all with passive aggressive NPs?

(Just note that if the NPs are ever sick or need to be intubated, you know dan well even THEY ask for *real* MDs and anesthesiologists!

 

[bulgethetwine]

Oh, I'm just curious because of what my former classmates were saying. They were essentially saying that physicians will refer a patient to the PA because the PA is 'better' at handling it, and they specifically mentioned difficult cases. Of course, these same students all said they wanted to be PAs because "You get to be a doctor, but for cheaper."

It interested me specifically because I've had nothing but extremely poor experiences with PAs. (An ER PA not only didn't realize from the x-ray that the bone I broke needed to be realigned, but also splinted it wrong, according to the orthopedic surgeon; suffice to say it caused me quite a lot of pain and agony in the long run because he did it improperly. He also introduced himself as a 'doctor'; if I'd have known he wasn't one, I would have asked to wait until a physician was available.) I suppose it's really a personal question, and not something that I want to know as a pharmacy student, certainly.

Just figured it couldn't hurt to see some opinions.

You get to be a doctor but for cheaper?

Uh, yeah, way to go there Descartes - so you'll save a few thousand on tuition to forego a lot in salary?

GO REASONING! Way to think the pathophysiology through on that one LOLOLOL

 

[bulgethetwine]

yeah, that goes over really well when we take ATLS and FCCS every 4 yrs and the difficult airway course every 3 yrs....
pa's on trauma teams do more than suture...our trauma pa's put in chest tubes, central lines, etc and follow the pts through their stay in the trauma icu....
see this thread and take special note of the multiple positive comments from attending docs who actually work with these pa's and np's:
http://forums.studentdoctor.net/showthread.php?p=9655546#post9655546

Oh please. Like ATLS teaches you anything. It's run by surgeons on 10-year old material for God sakes.

That's great that you "follow" them through the ICU.

The med students do that too.

 

[glade]

A wise person once said "there's nothing a smart person can't learn." Presuming that learning stops just because you're a PA is just dumb. To fail to take advantage of someone's experience and potentially superior knowledge is equally dumb. I know where the buck stops and I don't hesitate to make the tough decision but I'll be damned if I'm going to limit useful information from someone on the basis of their degree.

People who use these types of stories use them totally out of context. Do we all learn? Sure. Can we learn something from anyone? Sure. I mean, we always get these parables where even some dirty bum on the side of the road teaches this wise scholar something, or some sage is taught something by a child. But this misses the point. You don't see attendings asking medical students for advice, do you? And do you go, "oh, so you think you're too good to learn?" Probably not. There's a reason for that.

In fact, most of the people on here who usually ask PAs for info are in the ER and most of the PAs who are discussing this issue are ER PAs. I'll leave it at that. All I'll ask is, do you guys see your Vascular Surgery attendings asking their PAs things? Do you see your Cardiology attendings asking their PAs things? If you've been on a transplant service, you might ask a PA about protocols for immunosuppression, but that's about it. It's something you can get from an orientation binder.

 

[Socrates25]

A wise person once said "there's nothing a smart person can't learn." Presuming that learning stops just because you're a PA is just dumb. To fail to take advantage of someone's experience and potentially superior knowledge is equally dumb. I know where the buck stops and I don't hesitate to make the tough decision but I'll be damned if I'm going to limit useful information from someone on the basis of their degree.

So you therefore admit that there are PAs in your field with X years of experience who are more experienced and knowledgeable than you are. That being the case, we should fire you and hire them at half the cost instead.

Why do you deserve such a high salary when somebody with half of the formal training knows as much as you do?

 

[surftheiop]

You're confusing the issue. I've fgot no problem asking a PA in another field a simple question. On the other hand, am I going to refer a patient to a cardiologist to see his PA? Nope I want the cardiologist, not his PA.

The question is this -- would you, as an EM attending, routinely ask your EM PAs for guidance with patients? Because if you do, you are superfluous and there's no reason that society should pay EM attendings 250k per year when a PA making 100k per year can totally replace your job.

Either you offer value as an attending over a PA in your field, or you dont. If you dont, then I'd be prepared to get laid off or get a major pay cut.

I'm shocked that some people make it through undergrad without learning about basic logical fallacies.


http://en.wikipedia.org/wiki/False_dilemma

The logical fallacy of false dilemma (also called false dichotomy, the either-or fallacy) involves a situation in which only two alternatives are considered, when in fact there are other options. Closely related are failing to consider a range of options and the tendency to think in extremes, called black-and-white thinking. False dilemma can arise intentionally, when fallacy is used in an attempt to force a choice

 

[Rendar5]

I'm shocked that some people make it through undergrad without learning about basic logical fallacies.


http://en.wikipedia.org/wiki/False_dilemma

The logical fallacy of false dilemma (also called false dichotomy, the either-or fallacy) involves a situation in which only two alternatives are considered, when in fact there are other options. Closely related are failing to consider a range of options and the tendency to think in extremes, called black-and-white thinking. False dilemma can arise intentionally, when fallacy is used in an attempt to force a choice

Nah, he knows it's a logical fallacy. He's just trying to act badass for some reason.

 

[Arcan57]

Your idiot faculty needs to step down and let the RT run rounds then. What a joke. Why am I paying your attending 250k per year when a simple RT with only an associates degree knows more about vent management?

RTs (even more so then PAs/NPs/PharmDs) vary widely in their skill level. The ones I work with now are mostly good for getting ABGs, hauling the ventilator to where I'm intubating, and suggesting TVs that are in the 8-10 ml/kg range.

I've worked with RTs in the SICU that were wizards at vent management and lectured at MD-oriented pulmonary national conferences. Within the narrow confines of their training, most specialized ancillary staff (PT, nutritionists, pharmacists, etc) are going to be more knowledgeable than most MDs.

And you're paying the attending because there may be a few other things besides vent management that comprise critical care.

 

[glade]

I'm shocked that some people make it through undergrad without learning about basic logical fallacies.


http://en.wikipedia.org/wiki/False_dilemma

The logical fallacy of false dilemma (also called false dichotomy, the either-or fallacy) involves a situation in which only two alternatives are considered, when in fact there are other options. Closely related are failing to consider a range of options and the tendency to think in extremes, called black-and-white thinking. False dilemma can arise intentionally, when fallacy is used in an attempt to force a choice

You're quite wrong. It would be a false dilemma if the question was leveled at a resident, since the resident is still in training and therefore by definition they are not knowledgeable about their field. It would not, therefore, be valid to say "either you know more than the PA from day one or you shouldn't be here."

On the other hand, if, as was stated, an attending is routinely asking advice from a PA, they should be fired and replaced with a PA. That's not a false dilemma at all, merely your lack of understanding of the situation. The presentation of some of the PAs of being asked "routine" questions about things like how to administer lovenox or how to wean steroids is an attempt to say "I'm actually even better than some of these attendings, never mind residents." And, in fact, if that's so, then the attending should be fired because that's not an acceptable situation.

Maybe you need to go back to undergrad.

 

[glade]

I've worked with RTs in the SICU that were wizards at vent management and lectured at MD-oriented pulmonary national conferences. Within the narrow confines of their training, most specialized ancillary staff (PT, nutritionists, pharmacists, etc) are going to be more knowledgeable than most MDs.

Yes, but would you say that your RTs know more about the vents and managing them than your intensivists? See, it's true that an RT may know more about vents than someone in PMR or Path or even someone in IM who doesn't do ICU, but I'm not sure what the relevance of that is. The question is whether those ancillary staff are, in your estimation, even in the narrow confines of their "specialty," equal to people who are trained as physicians.

And if you genuinely think that they are, then either you're not aware of the complexities of vent management or else your intensivists are sadly quite lacking.

 

[surftheiop]

You're quite wrong. It would be a false dilemma if the question was leveled at a resident, since the resident is still in training and therefore by definition they are not knowledgeable about their field. It would not, therefore, be valid to say "either you know more than the PA from day one or you shouldn't be here."

On the other hand, if, as was stated, an attending is routinely asking advice from a PA, they should be fired and replaced with a PA. That's not a false dilemma at all, merely your lack of understanding of the situation. The presentation of some of the PAs of being asked "routine" questions about things like how to administer lovenox or how to wean steroids is an attempt to say "I'm actually even better than some of these attendings, never mind residents." And, in fact, if that's so, then the attending should be fired because that's not an acceptable situation.

Maybe you need to go back to undergrad.

Yikes, I guess medical school really does suck all the critical thinking out of some folks and makes you one gigantic dichotomous key that operates only on binary yes/no situations.

Whats so hard to envision about a situation where a person (the attending) knows more than a PA about 99.9% of a specialty, but there is .1% that the PA knows/does better because he has been doing this .1% of medicine every day for 20 years?

 

[Arcan57]

Yes, but would you say that your RTs know more about the vents and managing them than your intensivists? See, it's true that an RT may know more about vents than someone in PMR or Path or even someone in IM who doesn't do ICU, but I'm not sure what the relevance of that is. The question is whether those ancillary staff are, in your estimation, even in the narrow confines of their "specialty," equal to people who are trained as physicians.

And if you genuinely think that they are, then either you're not aware of the complexities of vent management or else your intensivists are sadly quite lacking.

As much as your attempts to make every response as inflammatory as possible makes threads more interesting, it doesn't make up for the sloppy logic. Despite your attempts to change the argument to "every (RT/PA/NP) is equal in knowledge of their field as a physician of that specialty", that has never been the contention. Did I say most RTs are better at vent management than ICU docs? No. Did I say that I had personal knowledge of RTs that extraordinary at vent management? Yes. I'll even give you that I implied that those couple of stellar RTs were better then the average intensivist at vent management. Having most likely not met these RTs, I don't think my statement if falsifiable by you.

 

[glade]

Yikes, I guess medical school really does suck all the critical thinking out of some folks and makes you one gigantic dichotomous key that operates only on binary yes/no situations.

Whats so hard to envision about a situation where a person (the attending) knows more than a PA about 99.9% of a specialty, but there is .1% that the PA knows/does better because he has been doing this .1% of medicine every day for 20 years?

It has nothing to do with being a dichotomous key. I'm just demonstrating literacy. What was stated was that the attending was "routinely asking guidance from the PA." There can be no argument about the situation. What made it worse was you jumped up on here all trying to be the one who was going to tell everyone how great you were at logical arguments and fallacies. Now you're trying to pull back.

 

[glade]

As much as your attempts to make every response as inflammatory as possible makes threads more interesting, it doesn't make up for the sloppy logic. Despite your attempts to change the argument to "every (RT/PA/NP) is equal in knowledge of their field as a physician of that specialty", that has never been the contention. Did I say most RTs are better at vent management than ICU docs? No. Did I say that I had personal knowledge of RTs that extraordinary at vent management? Yes. I'll even give you that I implied that those couple of stellar RTs were better then the average intensivist at vent management. Having most likely not met these RTs, I don't think my statement if falsifiable by you.

I never said "every (RT/PA/NP) blah blah blah." If you know an RT who is better at vent management than your intensivist, I'd be quite troubled. You two need to stop trying so hard to look open-minded and get real.

By the way, you're self-identified as an attending. Are you an intensivist? And if so, is your RT better at vent management than you? Or alternatively, are you not an intensivist but you just wanted to speak for them as to their level of competence in your estimation?

 

[surftheiop]

It has nothing to do with being a dichotomous key. I'm just demonstrating literacy. What was stated was that the attending was "routinely asking guidance from the PA." There can be no argument about the situation. What made it worse was you jumped up on here all trying to be the one who was going to tell everyone how great you were at logical arguments and fallacies. Now you're trying to pull back.

I've never once claimed to be master of logic/argumentation, if you noticed in my original post I only claimed to know about the most basic logical fallacies. (Fortunately even in the ivy league they don't require engineers to be any good at writing!)

I suspect I'm not arguing with the actual "you". I guess you know full well your "all or nothing" arguments don't have any logical rigor (and I suspect you don't even believe them yourself), but your smart enough to realize many people can be swayed by such argumentation.

So continue on, your posts are pretty amusing in that they are almost quotes of a what your would read in some undergrad psychology textbook describing "splitting" in borderline patients.

 

[glade]

I've never once claimed to be master of logic/argumentation, if you noticed in my original post I only claimed to know about the most basic logical fallacies. (Fortunately even in the ivy league they don't require engineers to be any good at writing!)

Actually, you did by implication, when you said that you were "shocked" that some people made it through undergrad without learning about "basic logical falliacies." You then proceeded to apply what you pasted from Wikipedia incorrectly. And now you're using an irrelevant appeal to authority by mentioning "off-hand" that you went to an Ivy League university. Like I said, looks like you need some more undergrad work, by your own estimation.

 

[surftheiop]

Actually, you did by implication, when you said that you were "shocked" that some people made it through undergrad without learning about "basic logical falliacies." You then proceeded to apply what you pasted from Wikipedia incorrectly. And now you're using an irrelevant appeal to authority by mentioning "off-hand" that you went to an Ivy League university. Like I said, looks like you need some more undergrad work, by your own estimation.

Like I said, nobody expects you to learn to write in engineering school

Anyhow, have a nice career, I'm sure you'll make such a capable attending MD that you have nothing to fear from mid-level encroachment

 

[glade]

Anyhow, have a nice career, I'm sure you'll make such a capable attending MD that you have nothing to fear from mid-level encroachment

Mid-level encroachment has little to do with the capabilities of a physician, either alone or as a group. It has to do with politics and finances. Like I said, you need to learn about things before you try to use them as insults or you just look foolish.

 

[bulgethetwine]

Mid-level encroachment has little to do with the capabilities of a physician, either alone or as a group. It has to do with politics and finances. Like I said, you need to learn about things before you try to use them as insults or you just look foolish.

And the winner is..... GLADE! with this fabulous, on-target quote.

 

[surftheiop]

Mid-level encroachment has little to do with the capabilities of a physician, either alone or as a group. It has to do with politics and finances. Like I said, you need to learn about things before you try to use them as insults or you just look foolish.

That wasn't an insult, like I said earlier I don't think the binary arguments the way your presenting them are what you actually believe. You just know they are effective for advancing your ultimate position (a position I essentially agree with). Given then fact we share a similar position there is no reason to split hairs over argumentation techniques employed to advance said position.

What I said about "competence" is obviously an oversimplification, but so long as physicians continue to demonstrate the superiority of the their care compared to competitors, then the lawyers will have no trouble destroying the competition when they provide sub-standard care.

 

[Arcan57]

I never said "every (RT/PA/NP) blah blah blah." If you know an RT who is better at vent management than your intensivist, I'd be quite troubled. You two need to stop trying so hard to look open-minded and get real.

By the way, you're self-identified as an attending. Are you an intensivist? And if so, is your RT better at vent management than you? Or alternatively, are you not an intensivist but you just wanted to speak for them as to their level of competence in your estimation?

Why does it cause you personal distress that one RT may be better at a specific aspect of patient care than a competent, board-certified critical care physician?

Would it be reasonable to describe your view of physicians as something akin to captain of the ship? If so, I think that's a very reasonable stance. However, if you work in a hospital setting (excepting anaesthesiology practicing minus CRNAs/AAs),you don't provide much direct patient care compared to the total amount of care they receive under your supervision.
And if your crew has suggestions, it's usually worth listening to them. Not because they're co-captains, but because they may have information you don't. If what they are suggesting is wrong or dangerous, you can educate them and you've (potentially) a better crew member. If it's a good idea and you acknowledge that, they feel motivated and do a better job.

 

[Socrates25]

Did I say that I had personal knowledge of RTs that extraordinary at vent management? Yes. I'll even give you that I implied that those couple of stellar RTs were better then the average intensivist at vent management.

If thats true, then one of the following is also true:

1. The intensivists at your institution are incredibly weak.

2. On issues of airway/respiratory management, you should be deferring all questions and management to the RT. You are doing a disservice to you patients if you openly admit that the RT is better at managing vent settings than you are. That means the RT, NOT YOU, should be deciding when patients get extubated, what kind of ventilatory support they should be on, what the settings should be, etc.

Either way, I never want to be in your ICU.

 

[Arcan57]

If thats true, then one of the following is also true:

1. The intensivists at your institution are incredibly weak.

2. On issues of airway/respiratory management, you should be deferring all questions and management to the RT. You are doing a disservice to you patients if you openly admit that the RT is better at managing vent settings than you are. That means the RT, NOT YOU, should be deciding when patients get extubated, what kind of ventilatory support they should be on, what the settings should be, etc.

Either way, I never want to be in your ICU.

1. No.

2. Doing a disservice to my patients if I admit that an RT is better with vents then I am? That's an interesting statement. Full of fail, but interesting. Since you seem to have not been following my description of the quality of RTs at my current place of employment (hint: read up on appropriate tidal volumes, especially in ARDS patients).

While I have disagreed with almost everything you have said in this thread, I also hope that you do not need to be admitted to the ICU at my hospital. Or any ICU for that matter.

 

[Apollyon]

If thats true, then one of the following is also true:

1. The intensivists at your institution are incredibly weak.

2. On issues of airway/respiratory management, you should be deferring all questions and management to the RT. You are doing a disservice to you patients if you openly admit that the RT is better at managing vent settings than you are. That means the RT, NOT YOU, should be deciding when patients get extubated, what kind of ventilatory support they should be on, what the settings should be, etc.

Either way, I never want to be in your ICU.

Is it Kool-Aid (actually Flav-R-Aid), or hemlock?

 

[glade]

So I note that arcan didn't actually answer my question about whether he/she is an intensivist and whether his/her RTs are more proficient at vent management.

 

[Arcan57]

So I note that arcan didn't actually answer my question about whether he/she is an intensivist and whether his/her RTs are more proficient at vent management.

As you have ignored any part of my posts that didn't lend themselves to inflammatory statements construct along the lines of "only weak physicians would ever ask for help from anyone". With the implied assumption that a physician automatically knows more about everything medical than anyone else, at all times.

 

[oldbearprofessor]

I am an intensivist who has practiced as a board certified attending for more than 20 years. My patients are babies, usually in the first month of life, often older. Every day I ask people who are also caring for these babies for their recommendations and suggestions.

Typically on rounds, I will ask the bedside nurse, the resident (or NNP), the RT, the dietitian and sometimes the PT, OT and occasionally the housekeeping staff for their suggestions, especially on long-term ventilated patients. Sometimes these folks can provide important insights that I may not have had. I may be an attending, but I am not on-service continuously and I do not know everything that has ever happened to a baby during their hospitalization. For example, our patients tend to stay for several months and have intermittent deteriorations. The nurses and RTs are likely to have some insights into what has helped these babies in the past. I can then accept or reject any of that advice, while explaining my decisions. When the housekeeping staff suggests we use a less noisy garbage can near the baby, I always take that advice.

Asking for advice from those who are the direct caregivers, regardless of their academic degrees, is a sign of knowledge, respect and self-confidence. It is not a sign of weakness or ignorance. It has many other benefits as well. This is not some sort of "touchy feely" approach to patient care. It is what works and has worked for me for over 2 decades.

 

[glade]

Ah, but that's completely different. See, it is absolutely true that nurses and RTs spend more time with the patients than the intensivist. They're the ones who are doing the grunt work and they're, at most, three-to-one with patients. This is in contrast to the intensivist, who is responsible for all of the patients and, clearly, is fewer in number than the other staff. So it is entirely reasonable for the intensivist to go to a nurse and say, "any concerns you had?" or for the nurse to volunteer that "this patient's IV site is infiltrated and erythematous" or for the RT to go and tell the intensivist that the patient's peak pressures are up.

What is not the case is that the intensivist then goes, "oh, geez ...uh, what do you think we should do?? I'm scared!! "

 

[BurnENickcoles]

I am an intensivist who has practiced as a board certified attending for more than 20 years. My patients are babies, usually in the first month of life, often older. Every day I ask people who are also caring for these babies for their recommendations and suggestions.

Typically on rounds, I will ask the bedside nurse, the resident (or NNP), the RT, the dietitian and sometimes the PT, OT and occasionally the housekeeping staff for their suggestions, especially on long-term ventilated patients. Sometimes these folks can provide important insights that I may not have had. I may be an attending, but I am not on-service continuously and I do not know everything that has ever happened to a baby during their hospitalization. For example, our patients tend to stay for several months and have intermittent deteriorations. The nurses and RTs are likely to have some insights into what has helped these babies in the past. I can then accept or reject any of that advice, while explaining my decisions. When the housekeeping staff suggests we use a less noisy garbage can near the baby, I always take that advice.

Asking for advice from those who are the direct caregivers, regardless of their academic degrees, is a sign of knowledge, respect and self-confidence. It is not a sign of weakness or ignorance. It has many other benefits as well. This is not some sort of "touchy feely" approach to patient care. It is what works and has worked for me for over 2 decades.

I think this is how most of us intensivists practice. Clearly, it is not dichotomous (i.e. never asking advice vs. being "scared" as Glade put it) but the truth is somewhere in the middle.

I ask nursing staff, mid-levels, RTs, (even family members) if there is anything we have miseed, if there is anything they feel we have under emphasized, or if there is any insight they might have. Frequently - the majority of the time - there is an important nugget here. I'm the attending, not God.

I will say, though, that while I do solicit advice and input from mid-levels and frequently use it to form my decisions, it is only when that advice and input is related to the very narrow scope of practice for which the mid-level is competent in that it makes a difference. I don't ask the cardiac PAs to consider what to do next with the empiric antibiotics. I don't ask the RT which ionotrope to wean next. All of these things I could ask a junior resident physician. Same goes for the RT - I might ask them what they *think* and if they have any ideas, mostly their main utility is knobology (and coming to me when they need advice or guidance when they detect changing physiology in one of their relatively few patients while I'm rounding on the whole unit).

Also, another poster mentioned that their impression was that the nurse/mid-level/RT spends more time at the bedside. While this may be true for ANY ONE PATIENT, I probably spend just as much (if not more) actually at someone's bedside during my day. There is a whole lot of sitting behind a computer screen by nurses and RTs these days while they chart as I'm at the bedside of one of my 16-22 patients.

There's another big issue that has been neglected in this discussion. And that is the ability to filter the information that DOES NOT matter. Even when mid-levels are so called experts in a narrow field of knowledge, to me one of the things that separates them from the physicians (even the fairly junior residents) is there ability (or lack thereof) to know what NOT to say.... what ISN'T significant.

This is significant drain on efficiency.

 

[glade]

Right, but I'm not presenting it as a dichotomy. The subject of the thread, the original post, was a question of asking a PA (and now we're also discussing techs and other ancillary staff) for help. And for the most part, that's what people were discussing. Only in the last few posts has it turned into "do you ask staff for input (i.e., details about the patient)?" which is completely different.

Specifically, it was stated by various posters that:

- Attendings ask PAs how to do things, even routinely.
- PAs have said that they are superior to residents in formulating plans and managing patients.
- RTs are more proficient than intensive care attendings at managing ventilators.

As I said, that's different from an attending seeing a patient and a nurse saying, "by the way, the patient was tachycardic last night." That's helpful, not "help." Hence my statement about "being scared." If you think you need help in that situation, as in "the PA/NP/RT knows more than me how to address the situation," then there's a problem. And that is the scenario that is being presented by a number of posters in this thread. And the reason for that is to suggest, big-heartedly, that we can all learn from each other. And while that sounds fantastic and wonderful, it's not the case.

 

[Carboxide]

Right, but I'm not presenting it as a dichotomy. The subject of the thread, the original post, was a question of asking a PA (and now we're also discussing techs and other ancillary staff) for help. And for the most part, that's what people were discussing. Only in the last few posts has it turned into "do you ask staff for input (i.e., details about the patient)?" which is completely different.

Specifically, it was stated by various posters that:

- Attendings ask PAs how to do things, even routinely.
- PAs have said that they are superior to residents in formulating plans and managing patients.
- RTs are more proficient than intensive care attendings at managing ventilators.

As I said, that's different from an attending seeing a patient and a nurse saying, "by the way, the patient was tachycardic last night." That's helpful, not "help." Hence my statement about "being scared." If you think you need help in that situation, as in "the PA/NP/RT knows more than me how to address the situation," then there's a problem. And that is the scenario that is being presented by a number of posters in this thread. And the reason for that is to suggest, big-heartedly, that we can all learn from each other. And while that sounds fantastic and wonderful, it's not the case.

This is true. The original question was related to asking PAs (and you can include NPs in there, probably) to develop treatment plans or diagnose because you as a physician felt they were better at it than you are. That may not have been made very clear by me...sorry about that, for any confusion.

If you look to my second post in this thread, you'll note that I was saying that my PA student acquaintances were saying that physicians refer patients to them because "the PA is SO skilled", essentially.

What I've gathered from this thread, minus all the wharrgarbl, is that this may indeed happen, but primarily in simple cases that a PA can easily handle where the MD's time may be better spent looking at other, more complicated patients. I also gathered that physicians will indeed discuss treatment plans with PAs and many residents and interns will go to them for advice, which does indeed seem reasonable.

 

[The right Path]

Also, another poster mentioned that their impression was that the nurse/mid-level/RT spends more time at the bedside. While this may be true for ANY ONE PATIENT, I probably spend just as much (if not more) actually at someone's bedside during my day. There is a whole lot of sitting behind a computer screen by nurses and RTs these days while they chart as I'm at the bedside of one of my 16-22 patients.

While I agree that the paper(computer)work is a significant and growing (thank you JCAHO) burden, this statement is GROSSLY untrue. Back to the issue at hand.

 

[Rendar5]

Seriously glade, you're arguing against people who are largely in agreement with you, but picking things to fight about (seems tyou could create a huge issue over what "advice" even means). It's kinda funny, but hey why not.

Since while I will ask PA's for advice as I would ask a PGYII or III, or ask about a 5th way of handling a particular situation when I know 4 ways already, I'm not gonna claim they're more expert in my field than me. It's mostly using them as a sounding board or to consider something new just because (there's so many equally correct ways of handling situations in medicine it's not even funny).

So I'm not sure you ever really disagreed on anything despite any arguments here...

 

[glade]

Uh, no. I disagreed with quite a bit on here. It's funny because the OP was able to get that from my last post.