My journey with ADVANCE began July 7th 2008 as I wrote about my days leading up to physician assistant school. I was excited, yet nervous, about what I was getting myself into. There were PAs in my life that encouraged me with words of hope and peace. They said the road would be hard, but each day would make me stronger. I remember feeling ...

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 ...

Friday was my last day as a full-time PA in orthopedics. We had two knee scopes. The day seemed typical. I arrived early so that I could read more from the Tintinalli Emergency Medicine Manual. The supervising physician noticed my studies and made some comment. I said, ''Yeah, I have to be constantly reading because I never know what will ...

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 ...

If you are interested in surgery, there might be a few things to think about. Yes, there is nothing like the rush of gowning up, seeing/holding the inner-parts, closing up the incisions and seeing the patient off to recovery. It is very rewarding, yet incredibly taxing. Is surgery for you?  I am in surgery 5 days per week. I will arrive ...

When considering my first job as a PA, a topic of concern was the commute. At the moment, I drive about 30 to 45 minutes each way, not to mention the time spent between the offices, hospitals and surgery centers. I initially thought this would not be an issue since I drove 3 years from Dallas to Fort Worth (1.5 hours round trip) for my PA ...