The nurse asked, ''What labs do you want?'' Like clockwork I responded, ''CBC, iSTAT, POC UA and UPT.'' I walked away thinking about what I just ordered. Really?  Are those even necessary? Am I simply in robotic-non-thinking-mode? My suspicions were confirmed when the supervising physician asked me, ''What are those labs going to ...

Triage is the act of prioritizing patients based on their probable diagnosis and necessary treatments. It comes from the French word tier, meaning to sift or to separate. Our ED has a ''triage'' area where patients are seen by a nurse who collects basic history and vital signs. We rely upon this information in our overall assessment. Last ...

As I write this, my body is suffering from a 9-hour jet lag and 4P-4A shift in the ER. On Saturday, I returned to the States after an 8-day trip to Uganda. Our purpose was to teach at a leadership conference in the northern part of the country. We flew in at 2:30 PM that day. On Sunday, my normal schedule resumed.  The shift was ...

Him, ''No English.'' Me, ''Uhhh, well, ummm, duele (pain)?'' Him, ''Spanish word, Spanish word, Spanish word'' and then points to his right lower quadrant as he writhes in pain. This patient began with the luxury of his PA using the translator phone, but as fate would have it, the phone lost service in the beginning of the evaluation. ...

The medical director said, ''We don't want you to make mistakes because they're too costly,'' when I asked him for some tips. My first day of emergency medicine orientation was spent one-on-one with the ED director. This one stood out. He went on to explain that mistakes are avoided by asking questions whenever you're unsure about ...

Next week I will start my new job in the ER. Along with reading my Tintinalli Emergency Medicine Manual, I have spent a little time at the PA Forum. If you have not been over there, they have a little something for everyone (pre-PA, PA-S, PA-C). Their emergency medicine section is packed with pearls of dos and do nots, odd ...

When starting your first job as a new grad, there are a lot of things required to be “official.” Not only are we paving the way to legally practice, we are dealing with the site-based requirements of credentialing. Transitioning to a different job is not as strenuous as the initial but there are still a lot of things to consider. Here are some ...

I have tremendous respect for my PA and NP colleagues in dermatology. With eyes as skilled as Picasso's, they have the horribly difficult job of identifying literally thousands of skin conditions, ranging from benign to deadly. Dermatology confuses me. It must me my engineering background. I'm more comfortable with mathematical equations and ...

Family medicine will sometimes follow you home, which can be a good thing. Last week my preceptor and I saw a few complex cases without clear causes. Each night I would go home and think about what might explain these medical mysteries. A few days later, the lab results would arrive, which would lead to more questions. Just when we thought the ...

I'm confused. I've been using Epocrates Essentials for two years now, and I love the program. The ability to look up diseases, medications, lab tests, tables and more has made this an invaluable tool in the clinical setting. Then, a few months ago, I downloaded Medscape from WebMD on my iPhone. One striking difference between the two programs is ...