Friday Night Vodka-Buzz. Ask me anything...

[Aristus]

And a lifetime of eternal friendship to all those who can cheer me up.

I just can't make the throw from deep-center anymore, Coach...

[VarryOn]

1. Well, what vodka? Nt

[Aristus]

3. Absolut Lime.

Just like last week. This week: I kill the bottle!...

[VarryOn]

5. Not too bad...

Definitely gets the job done!

I like mixed with club soda.

[Aristus]

7. I like it mixed with ginger beer and lime slices.

[sprinkleeninow]

9. Ginger beer! I'm hooked on it.

dumpski has a shrivelled 🌰 ou 🍄.
Oui oui.

[Aristus]

10. If it has 'beer' in the official title,

sign me up...

[sprinkleeninow]

12. I think I saw alcoholic ginger beer somewhere. Yum!

[Aristus]

14. Yeah. It's what helps make a Moscow Mule a Moscow Mule.

Although, given the fact that we are now a client-state to Russia, I wonder if I should give them up...

[sprinkleeninow]

20. One last one... noticed the copper mug and was gonna say

looks Ruskified. 💂?♀️
Nite! 🎅

[sprinkleeninow]

2. I wuz hopin' we already had a lifetime of eternal friendship. 💖

My daughter is over here snoring. 🤣

I misspelt wuz with wiz. Pardon me. 🙄

[Aristus]

4. Yes, we do...

My wife snores. See how much we have in common? Friends for life!

[sprinkleeninow]

6. Uh, let me clarify. Thas my dogga daughter. 🐕

Now she's woke up. And wants sumpthin from mommie. 🍬

[Aristus]

8. Oh, okay.

I misunderstood...

[sprinkleeninow]

11. It's me. I wasn't clear. It's not one of my better features. 🌝

[Aristus]

15. No judgement...

[tblue37]

97. Let's hope it's not Aristus's "dogga" wife! nt

[sprinkleeninow]

104. This exchange went kaplooie.

My fur-daughter was snuggled in one of her numerous beds nearby and was out like a light snoring. I thot it was coming from the teevee.
🙄 🐕 💤

[Aristus]

105. HA!

[sprinkleeninow]

106. You up? ☺

[Aristus]

107. I'm up.

And (mostly) sober.

Just a couple of beers tonight. How about you?

[redstateblues]

13. Tito's with syfo soda and lime

[Aristus]

16. Sounds good!

[sprinkleeninow]

17. Gotta blast. Laundry and numerous other stuff b4 I rack.

Na z'drovje, mon ami.

A peace-filled might be yours! 💤

[Aristus]

19. Dobre noche...

Da svidanya...

[sprinkleeninow]

21. Ooh, Ima verklempt fanning myself! 😍

[sprinkleeninow]

18. ...

[912gdm]

22. is it possible to do a Tracheotomy with just a steak knife and a ball-point pen?

You did say AMA.

[Aristus]

23. Theoretically.

Anything, as long as it works...

[TexasBushwhacker]

24. Isn't that an awful lot of blood for the size and location

of the incision?

[Aristus]

25. Yeah, it's a pretty vascular area of the body.

Hopefully, the EMT's help to control the bleeding when they show up...

[912gdm]

26. does blood irk you?

one of the main reasons I never went into medicine was blood. even seeing that movie scene has me curling into a ball and heaving

[Aristus]

27. Not in the least.

And it's worth pointing out that blood is far from the most disconcerting body fluid produced by the human animal. I've dealt with them all.

[3catwoman3]

28. I'll take blood over puke or poop...

...any day of the week.

[tblue37]

98. Or snot! nt

[912gdm]

29. so which fluid made you feel right at home?

[Aristus]

30. Well, nasal discharge.

That's what I see more than just about anything, I guess..

[912gdm]

31. how wholesome

[912gdm]

32. If you had a doctor...

would you feel it was tacky if he went onto a message board and complained about your questions?

[Aristus]

33. No. I would expect it.

We all need to vent sometimes.

As long as he didn't disclose names and dates of birth, have at it, I say...

[912gdm]

34. I would agree if it was among peers.

But you spill to everyone, doctor not not.

Im glad your not my doctor.

[Aristus]

36. Okay, then...

Physician Assistant, but whatever...

[912gdm]

38. well thank god for letting me know

you cant do as much damage as I thought.

Honestly, I thought you were a doctor. I couldn't imagine someone going through all that dissing this patient and that, outing this person and that, giving details and it was an actual doctor that went trough all that training. Your just a PA.



but yeah, the people that saw you need to get a lawyer just cause.


dumb ass PA thinks its a DR. HA

[Aristus]

40. Nice trolling.

You had me going there for a minute...

[912gdm]

41. and you had me at DR

[Aristus]

43. Never said I was a doctor.

And I never will. I practice clinical medicine. Every Lounger who has been here longer than a year knows that. Don't kick yourself.

[912gdm]

47. You dont practice.

you are a PA.


YOU ARE OT A DOCTOR

[mr_lebowski]

49. And every post I've seen of yours you are chiding people and overreacting ...

YOU ARE NOT BEING COOL.

[912gdm]

51. MEEeeeeeeEEEP

[mr_lebowski]

56. That's what I thought ...

Clearly broken.

[Aristus]

52. It's possible you are thinking of the title Medical Assistant.

A Medical Assistant is an allied health position similar to Licensed Practical Nurse, and who carries out many clinical tasks such as rooming patients, taking vital signs, drawing blood and obtaining other lab specimens, clerical work, etc.

A Physician Assistant is a medical practitioner who is trained on the medical school model, and practices medicine in many settings, including, but not limited to, primary care, family practice, specialties such as cardiology, gastroenterology, endocrinology, surgery, etc.

https://en.wikipedia.org/wiki/Physician_assistant

You're not the first to confuse the two. No shame...

[mr_lebowski]

60. Yeah there is ...

This person seems to want to pick fights w/people tonight for some reason. You're the 2nd person I've seen he/she fly off the handle with ... for no actual reason whatsoever.

Tell ya Aristus ... the fact that you could (in theory) write me an Rx for Oxy, and it would get filled ... tells me you're close enough to a proper Doctor for ME to call ya 'Doc', straight up!

In fact, I jumped in cause you don't deserve to be spoken to this way ... and to tell you that you have the patience of a Saint (not the patients though I'm sure) my friend

[Aristus]

64. Much appreciated..

Thank you, doctor...

[emmaverybo]

63. He knows as much, and yes, practices. PAs are very high up in the med profession. The highest

next to MD’s. In any case, Aristus is very well respected here as many many DUers friend and as a professional.

[mr_lebowski]

69. This person probably thinks a Nurse Practitioner ...

Is like a receptionist at the doctors office who's 'practicing' to be a Nurse someday ...

[Aristus]

71. Oh, he better not go there!

I know many Nurse Practitioners whom I respect very much. Even one I consider a kind of mentor. She helped me through the rough spots when I first started in practice. I'll never forget her kindness. Or her clinical acumen.

[Tiggeroshii]

74. I feel like some folks have just had a really bad experience with a PA once and feel the need to

take it out on random strangers.

[3catwoman3]

90. It doesn't even have tp be "really bad." It can just be...

...that they didn't get what they wanted, like an antibiotic prescription when there were no clinical indication for one.

In my 43 years as a nurse practitioner, it has been my experience that if a patient (or in my job, parent, as I work in pediatrics) has a single less-than-ideal experience with an NP or PA, they decide that none of us is any good and condemn the whole profession forever. I find this quite curious, because people are unhappy with doctors quite often, and for a variety of reasons, yet they don’t decide to never see another doctor.

In pediatrics, parents often bring children in quite early in the course of an illness. I once examined a child who’d had a sore throat for 30 minutes. At the very beginning of an illness, it is quite common for there not to be any specific physical finding to, as I put it, “hang your diagnostic hat on.” We always tell parents that new, worse or unresolved symptoms merit a re-examination. It is not unusual for a parent to jump to the incorrect conclusion that if a child is feeling worse 2-3 days later, that the NP or PA “misdiagnosed” something and failed to “nip it in the bud.”

You can’t nip something that isn’t there yet.

[Aristus]

110. I can't count how many times I've had a patient following up on an ED visit

tell me: "They didn't do anything for me!"

I'll read the ED report later and discover that the emergency medicine provider actually did everything to treat the medical complaint that standard of care called for. Just no opioid medication prescription. That equates to 'nothing' in the minds of some patients.

[pbmus]

35. My drink tonight is Stoli Chocolate raspberry with ginger and root beer with 8 cubes

My smoke is a bowl of lemon haze

And don’t ask me anything cause I reeeeeaaaaallllly can’t answer ..

[kimbutgar]

37. If you could meet one historical or current celebrity who would it be?

And if you can explain why?

[Aristus]

39. One of three: Voltaire, Oscar Wilde, or Mark Twain.

Reason: The dinner conversation, of course! Just imagine it!...

[kimbutgar]

42. Wow brother you are deep!

Love your choices.

[Aristus]

46. Have you ever heard the story about what Voltaire allegedly said on his deathbed?

It's hilarious!

[CTyankee]

89. Oh, Aristus, try harder...surely there's a woman whose conversation with you would be

Last edited Sat Dec 14, 2019, 01:39 PM - Edit history (1)

fabulous. I'd like a bit of Lillian Hellman, Artemesia Gentleschi, Costanza Bonarelli and Ella Fitzgerald. I'd also try for Aretha...

[Aristus]

94. Dorothy Parker.

Dinner and four dry martinis...

[CTyankee]

95. oops, how did I forget her? She kicked ass...

[cwydro]

108. "Four I'm under the host!"

She’s one of my faves.

[Aristus]

109. I was wondering if anyone was going to catch the reference.

[cwydro]

111. I used to be able to send my mom (who loved martinis) into gales of laughter by reciting that.

I love Dorothy Parker, and I have many of her quotes committed to memory.

She must have been a fantastic person to know.

[Tiggeroshii]

44. Is saying "that's projection," the "I know you are, but what am I?" for adults?

[Aristus]

54. I don't think so.

If the person doing the projection is also the one exhibiting the cited behavior, then no.

[Tiggeroshii]

59. Hmm....

But who's the best judge of when that's the case? If there is no objective party, then it's as good as a schoolyard taunt, no?

[Aristus]

62. Not if one can furnish evidence.

For example, if Trump called me a liar, I would simply point out the several billion instances in which he himself was a liar, and ask him exactly which high ground he thought he was standing on...

[Tiggeroshii]

66. But Trump will simply double down on the lying accusation, no?

There is absolutely no way to convince him he's a liar, because his ability for introspection is so limited...

[Aristus]

70. That's true...

[Tiggeroshii]

61. To clarify, when i see people actually projecting, I want to point it out, but realize

that the projection is often the result of their lack of self awareness anyways and it will do no good. So is it even worth it? Are there people who project who can actually admit they are projecting without taking offense?

[Aristus]

67. Sounds like one of those things that needs to be handled on a case-by-case basis.

Like pretty much everything else in life...

[Tiggeroshii]

68. Or I can just resort to alcohol.

Hold on while I pour myself a glass.

[Aristus]

72. That's more like it!...

[Tiggeroshii]

73. Boxed wine is a gift from the gods.

[Aristus]

75. And of equal quality as bottled wine, and more environmentally friendly, they say.

[Tiggeroshii]

76. I only found out about it a few months ago.

My reaction essentially: "HAS THIS BEEN HERE MY WHOLE LIFE???" I've been of drinking age for over a decade and knew nothing of it!

[Aristus]

77. Boxed wine got me through my twenties...

[Tiggeroshii]

78. Ooh man if only I had known about it then...

[Aristus]

79. You'll have great discoveries of your own to make...

And if you make some, let me know. Always eager to discover something new...

[912gdm]

45. In the future dont advertise yourself as a DR.

You are a PA...

[Aristus]

48. See my post above.

I have never said I was a doctor. I always identify myself as a Physician Assistant. Especially to my patients, who are the only people for whom the distinction matters...

[912gdm]

55. I want to know once and for all.

Can I do a tracheotomy with a steak knife and a ball point pen?!? Thats ALL THE FUCK I want to know!

[Aristus]

57. Everyone on DU, other than you, evidently, knows I'm not a doctor.

For the simple reason that I've been identifying myself as a Physician Assistant on DU since I got my license to practice medicine nine years ago. Eight years before you came along. So, once again, no shame...

[Hoyt]

101. Never seen Aristus misrepresent his credentials. Personally, I prefer PAs and Nurse Practitioners.

They are licensed to do most of the things physicians do, including prescribing meds, etc., and they are not stuck on themselves.

Best to get used to it, because PA/NPs are the future of medical care.

[Lithos]

65. Keto?

Also, what mix and what brand?

[PJMcK]

80. Why is LaGuardia Airport so horrible?

When my plane landed, all the bars were closed so no vodka till I got home.

[Aristus]

81. I don't know.

My only experience is with JFK.

But I feel you on the 'no vodka' thing...

[cilla4progress]

82. Aristus, on the topic of career paths,

have you heard of Limited License Legal Technicians?

I hope I'm not repeating myself..but we are akin to Nurse practitioners. And maybe physicians assistants. Washington is the only state that has the license so far - and I'm the 2nd LLLTto earn the license! We can have our own practice and dispense legal advice independent of an attorney-. Only ones in the US!

Also: I won a giant beautiful bottle of tequila tonight at the annual attorney Christmas party!

[Aristus]

85. I haven't, but that's interesting. Physician Assistants for the legal profession, it sounds like.

It makes sense; more and more people are needing medical and legal services, and there are fewer and fewer doctors and lawyers to provide them as the cost for professional training continues to skyrocket. Heck, I'm a PA, not an MD, and I'm still paying off my student loans nine years after graduation.

Congratulations. I know you'll do well. But prepare yourself for accusations of "You're not a real lawyer!" You can just tell them "No, but I am a real LLLT!"

[cilla4progress]

91. Perfect

👍

[diva77]

83. What prompted you to need cheering up today (technically, yesterday) ?

[Aristus]

86. Just a discouraging week at work.

Administrative nonsense, having to arm-wrestle my patients best two-out-of-three just to get them to get their vaccines, etc.

[diva77]

93. We applaud you for your noble work!

Perhaps this could come in handy occasionally :

[mercuryblues]

84. try Reyka vodka

next week. You will thank me in the morning. It is my special occasion vodka. Like when my trump loving brother comes to visit and stays at my other brother's house, instead of with me. Even when he comes over for dinner, he gets Smirnoff and I hide the Reyka.

Sometimes getting everything on my grocery list is a special enough occasion.

http://reyka.com/#?verified=true

[Aristus]

87. I'm actually not crazy about Reyka.

I tried it, and left the bottle unfinished. It had a pungent flavor a lot like gin; but if I want that, I drink gin.

[3catwoman3]

92. I know it is no longer Friday night, but how about a Saturday morning question?

A serious one.

What do you think of tele-medicine? And concierge medicine?

I want no part of either of these. If I cannot see it, palpate it, or auscultate it, I do not want to try to diagnose it. A couple of physicians in the consortium to which my practice belongs are venturing into this, and referring to it as care "on demand." I do not want to care for people who are so needy that they must have my personal cell phone number and access to me 24/7.

I think the "on demand" terminology is a terrible choice of words. Sounds like Netflix. Or a 2 yr old temper tantrum - "I want what I want, when I want it!"

Also - see my post 90 above. I'm curious as to whether your experience is similar.

[Aristus]

96. I'm not crazy about the idea of tele-medicine for the same reasons as you.

I've got to be able to look at it. No phone camera has the kind of resolution that can convey the same information as the human eye up close. And of course, as you pointed out, palpation and auscultation play a huge role in the diagnostic process. "Okay now, sir; please press your phone to your chest so I can hear your heartbeat." Nah; doesn't work for me.

As far as concierge medicine goes, I'm not going to discourage someone who wants to go into that kind of practice. One knows what one is going to get: rich assholes who think their money gives them the medical acumen to overrule your diagnosis. Although in fairness, I've had patients of every economic stripe tell me "I KNOW MY BODY!" when disputing my findings.

I've mentioned before why I don't treat pediatric patients; it's not the patients themselves, who more often than not are absolute angels; it's their parents; demanding, nit-picky, misinformed, allowing their legitimate concern for their children to manifest itself as haughty self-righteousness. People who think that disagreeing with and disputing their children's medical provider in an indicator of how much they care. I've had other medical providers tell me what a challenging field healthcare for the homeless is, and it is. But my respect is with pediatric care providers. You are all blessed with seemingly infinite patience and kindness.

[3catwoman3]

99. On the portion of the consortium's website...

...that introduces the on-demand option, there is a section advising parent about tips for a successful telemedicine visit. They are advised to have a flashlight on hand “for looking in the mouth and throat.” For who to look in the mouth or throat? The non-medical-professional parent to describe what they see, or the tele-doctor trying to do it via FaceTime? Not only no, but HELL NO! And rashes? They can be hard enough to diagnose when you are looking right at them in person.

In the list of conditions this on-demand service says it can handle are lacerations? What the hell are you going to do about a laceration on line, other than tell the parent whether or not to go to the ER for stitches? A telemedicine visit will have a flat fee of $59, not covered by insurance. How pissed will a parent be to be charged $59, only to be told to go to the ER. We do that now for free, when we are one call.

[Aristus]

100. Rashes. Ugh.

In school, all the slides and images one saw of various skin ailments were all pretty clear and distinctive. In clinic, everything looks like everything else, and it can get confusing. I've gotten pretty good at treating rashes clinically, since every dermatologist we refer to is always booked solid for at least six months.

[3catwoman3]

102. At your convenience, I'd love to know what you think...

...about my perceived blanket condemnation of us “mid-level” providers from those who have had an unhappy experience with one of us. We have a number of families in our practice who will not let me care for their children, often without ever having met me, and if the front desk attempts to schedule with me, a message in bright red letters pops up saying “Scheduling with (my name) NOT ALLOWED.”. I don’t particularly mind not walking into an exam room. I hate like hell walking in and being told to leave, especially when the parent tries the ”No offense” dodge. Pardon me for feeling offended when you have just told me you think I am inferior.

Oddly enough, no one has ever refused to talk to me when I am on call. I always identify myself as Mrs. XYZ, the nurse practitioner, both on call and during office hours. I never call myself a doctor, and when I walk into an exam room and the parent says to the child, “The doctor’s here,” I always say, “In today’s case, the nurse practitioner is here.” If a parent responds with anything along the line of the child not being able to say it or to tell the difference, I will respond with, “I have every confidence in your child’s ability to understand that there is more than one kind of person who can take care of him/her.”

I’ll bet you and I could talk for hours.

[Aristus]

103. Probably. You have some fascinating anecdotes.

I don't usually run into a lot of blanket condemnation of mid-level providers. Probably because, for a lot of my patients, any access at all to medical care is welcome and for which they have no complaints.

I've had patients who have visited almost exclusively with PA's in the past, had good experiences with them, and so are open and accepting when they establish care with me. Since I practice mostly at satellite clinics, at which there are no MD's, I get used to the autonomy, and patients get used to having a mid-level as their main provider.

I have patients who probably draw no distinction between MD's, PA's, and ARNP's, and often refer to me as 'doctor', even after I introduce myself as a Physician Assistant. For example, when I conclude the visit, and the patient says "Thank you, Doctor", I respond "I'm a Physician Assistant; feel free to call me Bob." Many of my patients go on to call me 'Doctor Bob' anyway. As long as I've have disclosed my credential to them, I'm fine with whatever they call me.

The first clinic in which I practiced right out of PA School was specifically designated for primary care for our homeless patients; the first clinic in town to do so. Prior to that, most of our homeless patients could only access care at a few scattered charity clinics. The kind of places that offer clinic for two hours or so, one day a week, in the basement of a church or someplace. I got the impression they were staffed by rather reluctant providers who had been 'volunteered' by their bosses, and saw clinic duty as their turn in the barrel.

The homeless clinic offered Monday through Friday, all-day clinic with a provider (me) who wanted to be there, and made it the focus of his career. I always wear a nice shirt and tie for clinic, to show my respect for my patients. (Clinic dress isn't always the measure of the provider, though. My mentor, a brilliant PA and a gifted clinician, practiced medicine in a pair of cargo pants and an old sweater.) The subject of dress led to one of my favorite experiences from my early days in healthcare for the homeless.

The clinic was part of a larger facility run by the city's development council, and had a front room where homeless 'clients' could sign up for services, take a shower, and use the laundry facilities. I provided the health care under contract with the city. The front area had its own manager, and we became friends. At the end of a visit with a new patient, I always give them my card and encourage them to come to the clinic for their primary care needs, instead of waiting eight hours at the emergency room. One time, the facility manager found one of my patients wandering around in confusion, holding my card and looking puzzled. She asked him was his concern was. He pointed to my card and asked "Is he going to be my doctor now?" "If you want him to be", she replied, deciding not to confuse him further with my status as a PA. "Is there a problem?" He kind of stammered for a little while, not knowing how to articulate his confusion. Finally, he blurted out: "He's wearing a nice shirt and tie!"

The manager and I had a laugh over that, and I understood instantly the root of his confusion. He was used to those reluctant charity providers who couldn't wait to finish with their required but (to them) unpleasant duty and get back to a mainstream clinic. He saw my nice shirt and tie as a symbol of mainstream care, and not healthcare for the homeless. He wasn't used to a provider who wanted to be there helping this kind of patient population.

In my first five years or so of practice, I think I only ever ran into the "You're only a PA! What do you know?" attitude a couple of times. And one of them was from a guy who wanted me to x-ray his brain in order to reveal the aliens living there. So I took his disdain with a grain of salt.