I really love EM:RAP, I mean, I REALLY love it. I listen to it constantly, I watch the videos, read the summaries and recently even spent my Friday night (that is 21:00-23:00 EST) listening to the EM:RAP Live session and I feel that I have been able to deliver better care to my patients because of it. This is why I was very disappointed when I heard Mike Weinstock using the term Midlevel Providers on this month's EM:RAP. This chapter reviewed the dynamics between different practitioners involved in the care of a patient who unfortunately ended up dying. The situation described sounds very familiar to me as I am sure it does to many other listeners. That said, I agree with many other Advanced Practice Clinicians (APC), as we refer to our colleagues in our hospital system, that the term Midlevel is inappropriate, belittles our experience and expertise, and misrepresents our role in the healthcare team. This is not an obscure issue, much has been written about it and the American Academy of Nurse Practitioners (AANP) released statements denouncing the use of MLP and similar terms and considers them derogatory.
I feel incredibly privileged to be able to do what I do for my patients in the ED and know that my actions, and not the letters after my name are what really matters. Nonetheless, I could not help but feel offended when a widely circulated and esteemed educational program used the term MLP, apparently unaware of the controversy.
I am also a long term subscriber to EM:RAP and an ED PA. A profession should have the right to define how they are addressed. PAs want to be addressed as PAs, not MLP, not APPs. That is not what we are. We are PAs and wish to be addressed as such. I imagine NPs would prefer the same. EM:RAP is a leader in ED educational community and should strive to set a standard. There is a push to clarify terminology by our national organization, AAPA. I’d refer you to the document from AAPA (and paraphrase a section below): https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2147486411 Phrases to Avoid * Inaccurate Terminology: "PAs are mid-level providers, physician extenders, non-physician providers, ADVANCE PRACTICE PROVIDERS or advanced practice clinicians." * These terms are often misunderstood by consumers and do not accurately portray or describe how PAs practice medicine to other providers or patients. Nor do they reflect their license or legal title. If PAs need to be referenced as part of a larger group, use "healthcare provider", "healthcare practitioner," or "clinician" but the preferred reference would include simply the title name of each profession (e.g., "PAs and NPs").
It is humane to do more in reducing suicide.. And EM is a place where there are overdoses and many disturbed and psychological distressed and dangerous persons . The Move to expect Emergency Departments to screen every body for suicide is too exacting and ought be more precise . Suicide can be prevented often associated with the impulsiveness and anger in the young and in the elderly lack of social supports as there loved ones and friends pass . I have heard patients say a health worker or committed friend saved their life .
I think you guys missed the idea on the work note discussion. I think its time we start fighting this. Its also important to know the rights of individuals. In NYC most employees are covered under the NYC paid sick leave law which says that employers can't ask for a note unless they miss 3 days of work. While this shouldn't be our job to inform people, we also shouldn't be wasting our time going back to our desk to get a patient a work note after they are discharged when they sneak that in at the end.
Hi Angel, Ken Starr goes through a pretty detailed explanation of how he uses gabapentin in this segment... https://www.emrap.org/episode/sayhellotobrue/opiate Let me know if more clarification is needed.
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Thomas R K., D.O. - October 1, 2016 9:45 AM
where is the download for the written summary?
TKonjoyan@aol.com
Rob O - October 1, 2016 11:04 AM
Hi Thomas, written summary is now available on the site.
Anand S. - October 1, 2016 9:52 AM
Looking into this now
Alon M. - October 4, 2016 7:20 PM
I really love EM:RAP, I mean, I REALLY love it. I listen to it constantly, I watch the videos, read the summaries and recently even spent my Friday night (that is 21:00-23:00 EST) listening to the EM:RAP Live session and I feel that I have been able to deliver better care to my patients because of it. This is why I was very disappointed when I heard Mike Weinstock using the term Midlevel Providers on this month's EM:RAP. This chapter reviewed the dynamics between different practitioners involved in the care of a patient who unfortunately ended up dying. The situation described sounds very familiar to me as I am sure it does to many other listeners. That said, I agree with many other Advanced Practice Clinicians (APC), as we refer to our colleagues in our hospital system, that the term Midlevel is inappropriate, belittles our experience and expertise, and misrepresents our role in the healthcare team. This is not an obscure issue, much has been written about it and the American Academy of Nurse Practitioners (AANP) released statements denouncing the use of MLP and similar terms and considers them derogatory.
I feel incredibly privileged to be able to do what I do for my patients in the ED and know that my actions, and not the letters after my name are what really matters. Nonetheless, I could not help but feel offended when a widely circulated and esteemed educational program used the term MLP, apparently unaware of the controversy.
Steve P - October 26, 2016 7:47 AM
Derogatory is hyperbolic. I'm not just an "ER doc" either but that's the term people are familiar with and it carries no malice.
Sara L. - January 31, 2017 12:32 PM
I am also a long term subscriber to EM:RAP and an ED PA. A profession should have the right to define how they are addressed. PAs want to be addressed as PAs, not MLP, not APPs. That is not what we are. We are PAs and wish to be addressed as such. I imagine NPs would prefer the same.
EM:RAP is a leader in ED educational community and should strive to set a standard.
There is a push to clarify terminology by our national organization, AAPA.
I’d refer you to the document from AAPA (and paraphrase a section below):
https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2147486411
Phrases to Avoid
* Inaccurate Terminology: "PAs are mid-level providers, physician extenders, non-physician providers, ADVANCE PRACTICE PROVIDERS or advanced practice clinicians."
* These terms are often misunderstood by consumers and do not accurately portray or describe how PAs practice medicine to other providers or patients. Nor do they reflect their license or legal title. If PAs need to be referenced as part of a larger group, use "healthcare provider", "healthcare practitioner," or "clinician" but the preferred reference would include simply the title name of each profession (e.g., "PAs and NPs").
Ian L. - October 23, 2016 5:00 PM
It is humane to do more in reducing suicide.. And EM is a place where there are overdoses and many disturbed and psychological distressed and dangerous persons .
The Move to expect Emergency Departments to screen every body for suicide is too exacting and ought be more precise .
Suicide can be prevented often associated with the impulsiveness and anger in the young and in the elderly lack of social supports as there loved ones and friends pass .
I have heard patients say a health worker or committed friend saved their life .
JohnMichael K. - October 31, 2016 10:13 AM
I think you guys missed the idea on the work note discussion. I think its time we start fighting this. Its also important to know the rights of individuals. In NYC most employees are covered under the NYC paid sick leave law which says that employers can't ask for a note unless they miss 3 days of work. While this shouldn't be our job to inform people, we also shouldn't be wasting our time going back to our desk to get a patient a work note after they are discharged when they sneak that in at the end.
Angel R. - December 20, 2016 11:21 AM
what is the dose for the neurontin for opiate withdrawal
Rob O - December 21, 2016 3:08 PM
Hi Angel,
Ken Starr goes through a pretty detailed explanation of how he uses gabapentin in this segment... https://www.emrap.org/episode/sayhellotobrue/opiate
Let me know if more clarification is needed.