Joint Effort PAs
We're two orthopedic surgery physician assistants discussing PA school, life as a PA, cases and topics related to orthopedics, and much more!
Joint Effort PAs
Can You Just Take a Look? Curbside Consults
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From evaluating mysterious rashes at family cookouts to examining swollen fingers at weddings, removing fishhooks on vacation, or answering texts that begin with "I know you're off, but...", the curbside consult is practically a rite of passage in medicine.
In this episode, we're sharing our funniest, most awkward, and most memorable off-the-clock consults—including the times we've found ourselves giving medical advice in grocery stores, restaurants, and living rooms. We'll also talk about where to draw the line and how to navigate those situations without damaging relationships (or your sanity).
Whether you're an orthopedic PA, another healthcare professional, or just someone who's ever cornered a medical friend with a health question, this episode is relatable.
Welcome to Joint Effort PAs, where two orthopedic surgery PAs get real about life in medicine. From tips and tricks to professional growth, work-life balance, and everything in between. We're here to share what we've learned and what we're still figuring out. Let's get into it. Let's take a look at this. Yeah. Let's take a look at all of the things. This so this is like an episode on the um the curb side consults.
SPEAKER_01Yes. We touched on this when it was very specifically co-workers. Yes. But I think what comes along with being a PA and then your friends and family know, friends and family, at least my family, doesn't really know what a PA is. You know, like sometimes they say PT, sometimes they say like medical. It happened last night. Well, we'll get to that. But um I think now that you like went to school and you work in a doctor's office, now everything's on the table for hey, can you take a look at this? Hey, can you tell me what to do about this?
SPEAKER_02Yeah.
SPEAKER_01Hey, my foot hurts. Can you can you look at it? Yeah.
SPEAKER_02And it happens all the time. I mean, not your husband knows, I assume, what you do.
SPEAKER_01So my husband does know what I do. Yeah, I think. He's like the only one in your family that is aware.
SPEAKER_02Yeah.
SPEAKER_01My kid, yeah, my kids still don't really get it. Um, but anyway, I think once someone learns that you are capable, now you are their go-to person. Yeah. And there are no boundaries. Uh, especially for you. No, there's no boundaries. Yeah. So, like, so this episode is called, Hey, can you take a look at this? Yeah. And if I had like a dime for every time I heard that, I'd be rich. Beth would be rich. I would be rich. Yeah. But here's here's like the real psychological part we're gonna dive into. We do take a look at that. And we will entertain all the things. So we're gonna go over some stories that we've had. Yeah. Um, and these are real.
SPEAKER_02Yeah, these are all real life, real case scenarios, real case studies, if we're case studies, if you will. Um, so story time. Um, well, first off, before we we get into it, we should briefly dive into the week's past because it was a whirlwind, so mine will be brief at least because it was such a whirlwind. Um but so I thought I had a full week.
SPEAKER_01Yeah, we did 23 cases this week. Yeah, you're projecting onto this week as things you don't have to talk about.
SPEAKER_02Correct. Yes. Your last week was a good week. Last week was a good week, like a lot of new and different cases. Um, we did like a humoral shaft fracture, a periprosthetic humeral shaft fracture. Yeah. Um good. Yeah. And a um uh elecranon, distal humerus, like a superchondrylar type deal. Um, those are always those are fun. The humoral shaft is like fun, but also I couldn't really see anything the whole time. Just like me somewhere. So like not fun in a sense. We did a ton of circlage.
SPEAKER_01Yeah, uh, you had to. Yeah. Yeah. There's no place it was great hardware, right?
SPEAKER_02Um and yeah, we did some finger fractures, we did a couple more, uh, we did another thumb implant. So it was great. It was a really busy week. I don't think I left the hospital until seven o'clock or later every night that we were there. Um, and then my doc is out of town for a full week and then only back for like a couple of days the next week before leaving again. So I'm using this coming week. Yes, I like I still am seeing uh patients on my normal um three days. But then I took our OR days off because I'm partially anticipating that like I'm gonna plan to get my life together those two days, you know, like clean my car and things leading up until the inevitable three weeks from now when shit hits the fan because it's gonna be so insane. Yes, I will have at least parts of my life taken care of.
SPEAKER_01So I mean that's that is good planning. Yeah. Yeah.
SPEAKER_02That's what I feel.
SPEAKER_01Yeah, definitely.
SPEAKER_02How about you?
SPEAKER_01Um, we had a good week. I was off the week before. So coming back, it should have been a crazy week. And it was and it wasn't. Um, we had our hospital cases on Tuesday, and the day before there was um a cancellation because our fill-in for our fill-in for our fill-in for surgery scheduling posted a case that was out of network. And this was like a case where we'd order a graft where it was an Oats case. So there's a lot of moving parts. So graft got ordered, patients out of network. Can we do the patient the next day? But then I can do them two weeks out. Is it a new graft? Do I have to send it back? Like, whatever. It was I was annoyed. I was like really annoyed that that got canceled. And then um we added on someone the week before when I was gone. It was a 16-year-old, didn't speak English, ACL. And then Monday, pre-op by phone. I was like, that's a terrible idea. Why did anybody why did we do that? Why I was like, I was there, but why did we decide that? So the kid doesn't pick up his phone, then he does tell him what time to get to the hospital, so go to the hospital the next day, and he didn't show up. They tried to call him and they couldn't get so anyway, he's 16, it's not his job, right? Right. So they finally get a hold of him. He's like, Hey, my dad's car broke down. Like, I, you know, I feel bad no showing, but I didn't show because of that. Yeah. I was kind of like, yeah, but this was set up to fail. Like I I knew that little feeling of like this is a you had the gut instinct that like something wasn't right. I knew it wasn't right. I knew we shouldn't have done it, blah, blah, blah. But anyway, we did. Um actually we didn't because we didn't show up. So our surgery day was cut short. I spent the entire afternoon getting all of my variables with scheduling down. And I went old school. I printed out calendars, went with a pencil and an eraser, and I fixed five or six like looming problems that we had.
SPEAKER_02Sometimes you did do you need like a good pen to paper.
SPEAKER_01It was pen to paper. There was no other way.
SPEAKER_02Yeah. There was no other way. Hey, those those side note, like the quick pre-ops right before, and sometimes it's inevitable. Like I'll pre-op somebody for surgery the next day for like a trauma. Break your wrist. You're out on my schedule Monday. We're planning to fix you Tuesday. Yeah, like I don't mind those, but um, like planned things that require some stuff going into it. That was one of my qualms of the week was like seeing pre-ops too close to time because I saw like a pre-op for a total and we're supposed to do it in a week, or it was less than a week, no clearances back, the scan had just come back, um, they don't have their labs or anything. So as I did a pre-op, I'm like, there's really even nothing for me to review right now because like how am I even supposed to do the pre-op? And how do I know that you're not gonna get like canceled now leading up? Because those are all bigotes. Yeah. And then I saw I did uh the the next thumb implant that we had that we did this week. Um, the name was like kind of recognizable, but not super recognizable on the schedule. And I knew we were doing a bio pro, but like always current me thinks that passed me, had it all under control. I'm like, oh, I did not set myself up for failure. I set myself up for failure. But the day before that case, I saw that patient for a pre-op. And our like the the national person in charge of like the company, the main guy of the company was coming flying down for this case, like not our normal local rep. So it was like a I don't know, we didn't want this case to go on well, you know. Um, so I see her and I had made note in my last HMP. I hadn't seen her for like five months, and I made note to myself make sure we get x-rays at her follow-up to evaluate the quality of her. You were setting yourself up for success. I I was, but it was the day before. So I hadn't x-rayed her in three years, and I get them, and I'm like, holy shit, like we can't do that. This one looks not like the best.
SPEAKER_00Yeah.
SPEAKER_02So I'm like panicking, texting our other reps, like, oh, can we have this on backup? And I'm like, God, like this is the this is the one that was supposed to go perfect and well. And I mean, it did. It actually fortunately did, and they were able to make a post on it on how sometimes it can be used to correct such severe deformity. Yeah. And so, like, that that went fine. But like I looked at it and I was like, okay, I have to remember to talk to my doc tonight and be like, hey, yeah.
SPEAKER_01This is okay. Yeah. I hate well, we talked about that a couple weeks ago. I had a patient that I was seeing, and it was multi-directional instability, which is not an imaging find. It's like your hands have got to be on the patient, you have to understand like how their shoulder moves. And I trusted my former self and I was so confident I set this patient up for surgery, but I made a note, like talk to the doc about this because he's gonna review this and be like, hey, imaging is normal. What are we doing here? Yeah. And I like lost sleep over it. Yeah, you know, just because I again I trusted my past self to set my future self up for success and I doubted her.
SPEAKER_02Yeah, yeah. My current self was like, what the hell was she thinking? I will say the times I've been the most burns are the times that I haven't even had that forethought of like, oh my gosh, I'm a little bit worried. I need to review this. Yeah. So usually when that's the case, it ends up being okay, knock on wood.
SPEAKER_01But um, yeah, yeah. And we had another case on Tuesday, which was like the shortest and most anticlimactic day. Um, we had a patient who was on Eloquis for shoulder surgery, right? So we get them off and it's two days. It's always been two days, right? Yeah. I mean, I was talking to our total joint PA and he said they do five days, but it's always two days, right? Yeah, yeah. So we got to the hospital and the new uh anesthesiologist was like, Hey, so it's three days. I can't block your patient. I was like, but last week it was two days, and every other day before today, it's two days. I've never, never had an elquest patient that the anesthesiologist haven't balked at anything. So this patient did not get a block, gave them some local, fast forward to 6 p.m. They're like, oh my God, it's so bad. Like, you know. Yeah. I was like, that was super annoying. Yeah. You know, but um other than that, I guess the days went okay. I have a rotating medical assistant because I'm waiting for mine to start. So every day was a new day. But I tempered myself correctly, hopefully.
SPEAKER_02Yeah, and then you'll have something more permanent and you can focus on the training, I guess.
SPEAKER_01Yeah. But we did another Misha. That was cool. We we hadn't done one in a little bit, and we have another one coming next week. So overall, it was a good week. It was, it was not as treacherous as I thought it was gonna be as I was away for a week.
SPEAKER_02Treacherous. Treacherous, that's a good word, right? It is. All right, story time, yeah. Story time. Okay. So first on the docket, splinter removals. Removing splinters. So your story on this.
SPEAKER_01I have a story on this. So I had um, it was Yurio, my sister-in-law and brother-in-law, brought our nephew down. We see him once a year, right? And he's um he's moderately autistic, so the sensory thing is a big deal. He's eight. They come over for dinner, so set up for oh my god, so good to see you guys, whatever. And it was like, hey, do you mind taking a look at the bottom of his foot? I think something got in there. So I was like, okay, did did anyone tell him I was gonna do that? They're like, no, you know, I figured there'd be so much going on, he'll be so distracted. I was like, that's cool for me, right? So I look at the bottom of his foot, it's it's infected. Like it's infected, like near his heel or uh in the bottom of one of his no uh no in the bottom of the foot, like right in the pad of the foot. Okay. Like, how is this kid walking? Like it looks like it's red, there's white, there's pus, there's all that. I was like, okay. So um, you know, I'm trying to talk to him, I'm trying to explain to him like what a splinter is. Now I've got my like eye tweezer like pickups or tweezers because like I have not I didn't have anything at home knowing I was gonna do this. Um, he's screaming, he's crying. I kid you not, I pulled out of this kid's foot what looked like a toothpick that was the size of like a pencil eraser.
SPEAKER_02Oh my god.
SPEAKER_01Like it was so satisfying, but at the same time, are you kidding me? And now I'm pretty sure he's like scared of me. Yeah, well, he is. Yeah, he definitely is, yeah. Yeah.
SPEAKER_00But I was like, what, like, what in the world?
SPEAKER_01So, and and fast forward to a year later, they're here now, and I just got a picture on my phone of his um thigh that looks to me like a spider bite. But they're like, Hey, do you mind taking a look at this? I think he has Lyme's disease. I'm like, uh, I mean, definitely not in my wheelhouse. Yeah. But I also found myself giving advice. Like, hey, I think it's the spider bite. Like, it's enough in your wheelhouse, though, that's but like I didn't shy away from it. Like, I very much, okay, but I was set up with the splinter. Like, can you? Once I looked at it, I was like, someone needs to. Like, yeah, it was the weekend. It's not like they were gonna go anywhere. So it's a little bit set up. So it was a choice that I decided to like dig at the bottom of his foot, and now he like has like an issue with me. Well, maybe he doesn't, but I assume he does. Yeah, he's a choice with that. And with the rash, I could have just been like, hey, yeah, no, that looks totally Lyme disease, and thought in my head, that's not Lyme disease.
SPEAKER_02But yeah, but then I don't know, I don't want to be like lumped in with somebody who's wrong.
SPEAKER_01I don't either. I didn't want to comply with like the advice when I didn't agree with it, but then then I'm bowled reaping it. Like now in you are yeah, now you're a part of it. So um, but yeah, so that that I get asked um a bunch. Or like, can you look at this like rash that I have? Uh-huh. Like rashes are my area of expertise. They're not, and I'm like, pretnisome, dude. And even when you get to the dermatologist, guess what it's gonna be? Prednisone.
SPEAKER_02So yeah, chat GBT it. I don't know. Yeah. Um, what it what did you do with your dad's ear?
SPEAKER_01Oh my god. So my dad recently had a total knee, and I set him up at our practice to have his total knee done. Long story short, or short, you know, long story long, he came in for his hip, got an x-ray of his hip, then got an MRI of his hip, which I didn't totally agree with because he's 75. It's either arthritic or it's not. Took six weeks to get an artrogram, which is what was ordered. Then he came in by that time. I I literally was just like, Can you give the guy a shot? That's what I set him up for. And I thought I was doing a good thing, but it turned into six weeks. That's the arthram, comes back in. Guess what? It's arthritis. By that time, yeah, hips not bothering him, it's his knee. So he goes in for the hip discussion visit and like, hey, it's arthritis. My dad was like, Cool, but my knee, and he's needed a knee replacement. He's like, you know what? My knee hurts tomorrow, let's talk about my knee. So he leaves, signed up for a knee replacement. So I'm like, Dad, did you get a shot in your hip? He's like, No, they didn't talk about my hip.
SPEAKER_03I'm like, oh my God.
SPEAKER_01Right. So when we talk about the knee, he goes, Well, they want me to make primary care clearance, and I'm so pissed off at my primary care doctor right now because I've got these, I've got a double ear infection. I'm like, Dad, you're 75. Like you don't have a double ear infection. You're not a toddler that goes to preschool, right? It's been going on for two months. Okay, first of all, two months. I said, Dad, it's not an ear infection. They sent me to ENT, they gave me these stupid drops. It doesn't work. I can't hear out of my right ear. Now it's traveling to my left. I was like, okay, listen, 75, and again, I'm doing a board scene right now. Most common cause of hearing loss in a 75-year-old is earwax impaction. So I'm like, Dad, I go, go get go to the urgent care and get like the lavage.
SPEAKER_02Yeah.
SPEAKER_01I don't trust anybody, I'm not doing it. How about when you come down next time? You can do it.
SPEAKER_00I'm like, uh, like, and I said, okay, right.
SPEAKER_01Yeah, sure. So hydrogen peroxide, a little bit of saline. Of course, I go down there, I forget all supplies. So I'm like, mom, what do you have? That's a syringe, right? So she's she's got like a like a turkey baster. All right, whatever. This will do. So I got my dad's head on the counter, lavaging his ear, whatever. Guess what? Fix my problem. Yeah. Yeah. Like, is it in my scope of practice? Yes. Well, I mean, I was more mad that no one else would do that. Yeah. Two months later, yeah, and no one else would do that. Yeah.
SPEAKER_02I like to think of myself as somebody who will do just about anything. And sometimes that burns you, sometimes it doesn't. Yeah. So let me ask you about your dog. R.I.P. rooks. And I didn't kill him by this. Just throw that out there. He died by other means of old age or cancer or something years later. Honestly, I mean, what I was trying to aspirate could have been the cancer. Okay, back up. So back up. The dog. The dog had a very large mass on its neck. Like near its throat. Um, and you know, like old dogs get like lipomas and stuff. So like I know what a lipoma feels like. This was very much like a cyst, like it was fluid-filled. Squishy. Yeah, it was squishy, like you could you could tell. Um, so my parents were like, Oh, we're not gonna take the dog to the vet. Like, we're not those kind of people, not that like they're not bad people, but like we're just not like take your dog to the vet for everything kind of people. Um, they're like he's probably dying anyway. So I was like, well, like it's fluid filled, so like I can like take some fluid out, right? Like, I guess I can aspirate his neck just like I could a person's knee or something, right? Yeah, exactly. Easy, it'll be easy. Um so I brought home some lidocaine and an empty syringe and an 18-gauge needle, and tried to have my dad hold this sounds like a torture story now, hold down the dog so that I could aspirate his neck. Did you do it? Long story short, it was a dry tap, and the dog wouldn't like the dogs don't cooperate. And perhaps this is the reason that I shouldn't attempt these things on animals is not being someone who is um in veterinary medicine. Um, because they're really hard to like control and you can't sedate them. So like he just wouldn't, even like with being held down and he's a smaller dog, like they're just not letting you do anything.
SPEAKER_01Yeah, and you don't you can't talk to them out of it.
SPEAKER_02Yeah, I'm not like just calm down for 10 seconds, okay, and then you'll stop feeling it.
SPEAKER_01Um I also have tried to do stuff on my dog, my two dogs got into it, and then one of them had like a full thickness, like laceration. Like, this needs a stitch. Yeah. So again, I had my husband like hold the dog down, headlock, and the second I touched the dog's skin, bucked, went crazy. I was like, I'm way over my head.
SPEAKER_00Yeah, way over my head. This is stupid. Yep.
SPEAKER_01Um, and we brought into the vet, and the vet was like, we will need to literally put them under general. I was like, okay, that makes me feel better.
SPEAKER_02Yeah, yeah. Like, so it wasn't just me. But what is it about us like that? We were like, Yeah, you can I will say the only success story I have had with it is when I had chickens, one of my dogs got into the chicken coop and it pulled out one of the like uh, I'll call it a teenage chicken. It was like not quite full grown and pulled it out. So it was a child. It was a child and it drug it around the yard, like playfully. I wasn't trying to kill it, but it was like, you know, just had it held in its mouth, let it go finally, and it was bleeding and it had a huge laceration across its neck. It's always next. Always next. And like for a chicken, I guess that makes sense. That's where I picked it up from. But um, yeah, I had monocryl in my house, and I was like, I'm gonna suture the chicken's neck because I don't have to take these out, I'll just let it dissolve. Like it'll be fine. Um, and the chicken was actually very cooperative. Interesting. So like we held down the chicken because it lost so much blood or I think just because like it was so startled or traumatized. And chickens, if you put them like in a certain position, I don't know if they're like sharks or stingrays or whatever, you can kind of like get them in a like a cathartic state where they really don't move. Um, but we held the chicken down and I stitched back together its neck and then I kept it like quarantined in my house in a little Tupperware container for a week, let him recover, and then I set him back outside and reintroduced him to the flock. It was great. Three days later, a hawk came by the house, picked him up, and ate his head off, and I found him dead.
SPEAKER_01Oh my god. I was not expecting that turn of events, but I think you you gave him a couple extra days. Yeah. It would have been, I think it was tragic. Like it was tragic in general.
SPEAKER_02It was more tragic for me when the chicken died after I had put all that effort into it. I was like, fuck, why that one? Like, why did you choose the one I just nurse back to health to maybe like the hawk could sense it was like the least well of the chickens? I don't know. That's insane. Yeah, I just came home from work and I found it beheaded in the yard, and I was like, what the fuck? Like that's all that work.
SPEAKER_01But that's also like an F you right to you. Like how you tried, look at that. And the hawk's like, Yeah, no, I see. Oh my gosh. I had um, this is like a couple years ago. We were at a party at a friend's house over the summertime, and um there was an in-ground pool, and everybody was pushing everybody, and someone pushed somebody, and instead of going into the pool, they landed short and shin to shin to concrete instant, right? So um looking at it, or you know, at I don't even think I saw it happen, but uh they were like, hey, is it you know, but Beth works in ortho. Can you can you take a look at it? It is like fillet open. Yeah, there's subcutaneous fat everywhere, right? They're like, Hey, do you do you think this needs to this needs to be fixed? Yes, it needs to be fixed. Like, and I have um I have suture stuff at home because we cover football and whatever. So I was like, uh, do I engage and be the person, or do it, you know, we just tell them to go to the ER and spend the entire night there and disrupt everything? So I engaged, right? So um went to my house, got my stuff, came back, literally sutured up her shin on her bed, sterily, maybe. I think hopefully. Not sterily, yeah. Um that's like side lines. Yeah, and then and then after you know, afterwards, they're like, oh my god, you can never go out. And like, how do you how do you like let let your guard down? And how do you exist? I'm like, well, you guys asked me, so the answer is I don't hang out with you. That's how it happens. Like I can't hang out with you if you guys know that I'll do stuff. But It's a self-fulfilling prophecy. Like they'll continue to ask if I continue to do. Yeah. But I'm not gonna look at a juicy laceration and send it somewhere else. No. And then criticize how shitty it was closed. Yeah. Right. Why do you do that?
unknownI don't know.
SPEAKER_02I don't know. Yeah. That's why. That's part of the reason why I say yes, because like I want to, I want to have my hands in everything. Everything. Yeah. Literally in everything.
SPEAKER_01Yeah, but um, yeah, I mean, I can keep going. Like my my husband shoved an oyster knife through his hand day before Easter. So um sutured that up. Um had a recurrent cyst on a recurrent elbow.
SPEAKER_02We we just addressed this issue. We did, yeah. Ten minutes ago on the back of the elbow. Yes. Um, I don't know. We were hoping it was a teratoma.
SPEAKER_01I think it was. Yeah, when I talk about it in the future, it was.
SPEAKER_02Yeah. Yeah. There was definitely a tooth inside of it. Yeah, this is a recurrence.
SPEAKER_01There's a recurrence sciss on the back of my husband's elbow that I attempted to excise a year ago. I did partially, it was gone, and then it recently came back.
SPEAKER_02Yeah.
SPEAKER_01And I sent Hannah a picture of this that I actually marked up with a heart around it. Yeah. It's cute. Because we excised that today. We did. And it was a two-man job.
SPEAKER_02It was. It was bigger than I anticipated. We're just surrounded by more adherent things. Yeah.
SPEAKER_01But theory is he leaned on something, something got in there, and then there's calcification around it. But what we pulled out at the epicenter was a tooth. Yeah. According to him, it was a baby jaguar tooth. A baby jag too. According to us, it was it was like a baby dog tooth. Yeah. Which arguably probably was in there for years.
SPEAKER_02Yeah, like did one of your dogs when it was a puppy, like, and then like it went inside of his elbow and um, or it's his twin.
SPEAKER_01It's his twin, right. We also said that it's a mini him growing inside of his elbow. Like a Danny DeVito situation. Like the other version of him. Yes. Um, but is it ego-driven? No. I mean maybe a little bit. I don't know. A little bit. Yeah. A little bit. I like to say no, but probably. Well, here's the thing. We should be able to excise a cyst on the back of someone's elbow. Yeah. We I mean, we know how to do that. If I were seeing that as a patient and it was assist aspiration, I can do that. Yeah. But that was not aspiratable.
SPEAKER_02That was not an aspiration thing.
SPEAKER_01You can't aspirate a jaguar tooth out of something. Um again, like more psychological. Are we are we just um people pleasers? Correct. Yeah. With with a side interest in procedures.
SPEAKER_02Yes. I think we uh uh have a procedure obsession. Now, I'm not gonna try to lump myself into the procedure goblin that we have discussed before because I don't want to be that person.
SPEAKER_01No, no, no, no. We're just dabbling with a little toe in the water.
SPEAKER_02Yeah, yeah. I I have interest where my interest should be, I think. I feel fine. Like, I'll take some cysts and lumps and bumps out. I'll do some splinter stuff. I took now these are patients, but like I've taken fish fins, like the little spikes out of patients before. Somebody came into urgent care like four weeks ago and had like a fin from bass fishing or some some sort of like spike from their fin lodged in their leg, like yeah, inside of their lower leg. And they were trying to check in, and everybody was like, No, I'm not gonna do that. And I was like, uh I will. Yeah. So I'm free. We did, yeah. I got it out. It was a pretty decent sized fin. Um, I've taken out yeah, actually multiple fish fin situations. There's a lot of that.
SPEAKER_01I had a um, I had a patient, it's actually one of our rep's kids. This was Easter weekend too, just happened to not be the oyster knife in the hand weekend. It's a couple years ago, many years ago, and they were fishing, and brother A casted the line into brother B's forum. So the is a it was like a deep sea fishing hook. The hook was in the forum. Yeah, you can't just pull those out. You cannot just pull it out. So um I got a text from the um the rep, and the rep was like, hey, so got like a problem. And again, could they have gone to the ER? Sure. Am I fully capable of doing that? Yes. So I did. I had him come in here, nubbed it up, pushed it all the way through, cut the hook off, and then brought it back out. It was it was very set aside.
SPEAKER_02Oh, like you push all the way through and then you cut the line and then No, I pushed all the way through because it had like a little dagger on the end of it.
SPEAKER_01So you can't like pull it right out. So I used a ring cutter to cut that. Then I pulled it all the way back through. Yeah. Um nice. Yeah, it was great. And I told the mom to put it in his Easter basket the next day.
SPEAKER_02But I think you told your husband to play with his cyst after. I did. I did.
SPEAKER_01I did. I told him it was okay. No judgment. Yeah, no judgment. Um, but I think I think we are, you and I are both, um, we identify with that part of ourselves that we like to we like to do the hard things.
SPEAKER_02Yeah. You don't get better without trying to do the hard things. That is true. Yeah. Now, what's the line? What's the line? Yeah. Um, I mean, I feel like I have a pretty good sense of like when something's like, uh, that's like really outside of my scope. Like true general medicine stuff, I really try not to mess with. Yeah. Like, I'm not gonna switch my patients' meds up if they ask, like, oh, my primary care doctor, like, it's so hard to get a hold of them and like my blood pressure is all over the place. Yeah, could you just like help with it? No. Yeah. I mean, I will prescribe like I will help with some primary care things. Like, if, you know, they know that every time they take antibiotics, they get a yeast infection or something. I'll prescribe stuff for that. But I'm not gonna like, you know, refill their meds that they can't get a hold of their primary for or like overstep my bounds in those cases. Or I've had patients before where I've really wanted to, where like in a pre-op I find out they're on blood thinners, and I'm like, what do you take this for? And they say, I don't know. Like they told me I had a blood clot like 20 years ago, and they told me I needed to take it for this amount of years, but then they keep refilling it and they never told me to stop. And I'm like, No, you can stop. Like, yeah, like I want to just tell in those cases, I'm like, okay, I think you're okay to stop, but like I want you to talk to them because now you're already giving me vibes that maybe you're not like super educated on what's going on. So like you figure, figure that out. So I'm not the one to like, I don't know. Yeah, you have something else actually going on that you were taking it for. Yeah.
SPEAKER_01So I mean, ethically, I find myself, I think that there are lines, right? If it's in my scope of practice as defined by what I feel comfortable and also what my dog would feel comfortable with, I feel like I I could do that. Like the the risk benefit, right? Like my dad, you know, irrigating his ears. I feel like that was okay. Yeah, yeah, it was okay to do that, right? Removing a splinter from my nephew's foot. It was okay. I didn't love it, but I I feel okay doing that. Yeah, right. Uh repairing a laceration on um my friend's shin. I feel okay doing that. If I were on a plane and someone's like, hey, is there a medical professional here? Oh, or story time, I was covering a football game and one of the coaches started having chest pain. So they came over to me and I was like, Whoa, whoa. Like there's an EMT right over there. Yeah, they know this more than that. They hooked him up to like the A C D just to get his um uh his uh rhythm, like to see what his heart was doing. And they're like, Hey, what does it show? And I was like, Oh, guys, guys, guys, guys, guys. I was like, like these uh look so fast, you know. But I was like, I'm not, don't don't take do not take my word for what is going on there. Like that, that type of stuff. I feel like whoa, way in over my head.
SPEAKER_02No, no, not anything that's like life or death, absolutely not. That's hard to draw the line.
SPEAKER_01Yeah, no, I am not a critical care PA. Right. Uh, but like the neighbor stuff. I had um a neighbor who was in a motorcycle accident. He was by himself and he tried to jump a curb and literally like faceplanted. So he went to elsewhere and um had mid shaft clavical fracture, among other things, whatever. And I didn't know any of this until the next day when his wife called me and was like, hey, so I'm out of town. I guess he got in this motorcycle accident. You know, is there any way you can go over to the house and like help him like get dressed and whatever?
SPEAKER_00So I was like, uh, like, what am I gonna say?
SPEAKER_01No. Yeah. So I was like, yeah, okay. So of course then I'm over there. I'm like, hey, can I see, you know, I'm gonna see your x-ray. And they're saying, hey, it's non-surgical. I'm like, bro, that is 100%. Like, so now do I insert myself and tell him what to do? Then I'm looking at the meds he was given. I was like, I don't agree with that. Like, I, you know, so I was like, Oh, we'll help him get dressed. And I saved all my internal thoughts for whatever. But here's the thing the orthopedic person that he was seeing, I was like, Hey, you know that's that's what I do. Yeah, like I do that. I actually do that on the shoulder. Yeah. And I had, you know, recommended he come in and see us, and he didn't. So here's the thing, like I was asked to help a little bit. I was very available, but I got no business out of that.
unknownYeah.
SPEAKER_01So at the end, I was offended.
SPEAKER_02Yeah. You're like, did you take my advice, did you not trust my advice, or did you just decide to take it and run with it all?
SPEAKER_01Or did it was it awkward with you that I had to get you dressed and now you didn't want to engage with me in that capacity? Because it was awkward for me. But what are you gonna do? His wife called and was like, Hey, do you think you can go over there and help him? He literally cannot get dressed, and then he couldn't, he didn't even have the strength to like get his pill bottles open. And I was like, Oh my god, I'm okay.
SPEAKER_02You're like, I guess I'm a home health nurse now. I know, but like that's I don't know. Yeah, I said yes. Yeah, it was it was a concent it was concentric. You help patients to the bathroom when they you have done that before. Oh my god, yes, I have done that.
SPEAKER_01Yes, help patients to the bathroom. Oh my god, yeah, yeah, all those weird things, but it's it's half on them. Yeah, they take advantage, there are no boundaries, but it's half on us because we say yes all the time.
SPEAKER_02Yeah, I will I want to say yes to most things because I want I want the experience in it. Yeah. Like, will I ever get to pull a baby jaguar tooth out of somebody ever? Ever again. Unless it comes back, I guess. I don't know.
SPEAKER_01Maybe we we don't know. Yeah. Um, last night, again, just closing, I was at a surprise birthday thing last night. And I remember a year ago, something like that, one of my friends was like, Hey, my niece, she's like 16, 17, she's a cheerleader, she lives in Jersey, she tore her ACL. I told her that you do that. Do you mind looking at her MRI? And I was like, uh, like formally, informally, are you gonna screenshot it to me? Can you just tell me what it says? There's a 16-year-old tore ACL. I was like, Oh, she needs to get that fixed. Yeah, that was it. I met the girl last night because she was in town, whatever. So my friend who was there was like, oh, hey, remember I told you I had this PA friend. So I thought it was gonna be a, oh, hey, yeah, did you get that done? How does it feel? Like, you know, yeah. I'm so glad you're on the other side of it. So it turned into, um, she got it done in December. It still bothers her. This is what they use for her graft. She ran out of therapy visits. Do I think she's cleared? And I was like, I mean, she had a dress on, she's like showing me her knee. And then it turned into like, I want to go into occupational therapy. Can you describe the difference between the two? Do you think that this would be, you know, if I were to do a college essay, do you think you can read it? And I was like, oh my God, stop. Stop talking. Like it was so much. It was so much. I thought it was gonna be like a quick, quick and easy whatever, and it turned into like a lot. Yeah. But I was like flattered. It is. It's like it's flattering. So part of me was like, oh, that was that was nice. But also part of me is like, Sometimes I'm like, Do you want to know anything about me?
SPEAKER_02Like Am I stroking my own ego by like, oh, they are asking me questions and like want my advice with it?
SPEAKER_01Um Yeah, but that has nothing to do with me. Like they weren't there to talk to me because I was interesting. They were there to talk to me because they served a role for them.
SPEAKER_02Yeah, they wanted something from you.
SPEAKER_01Yeah. So although flattering at first, I left and I was kind of like, ugh, that felt Am I used? That felt used. You know what I mean? Like I don't know.
SPEAKER_02Like never mind, I'm not gonna use it.
SPEAKER_01Okay. Anywho, um anyway, but yeah, it I think it's inevitable. Um, know your scope of practice, know a great way to get out of it, understand why we like to do that. And I think it's a nice balance between there's confidence replying, then there's wisdom and knowing going through this so many times, you eventually will know what you do and what you don't do. Yeah, you know, um when not to recognize when not to engage. Yes. So agree.
SPEAKER_02All right. Well, next week is our birthday, our one year anniversary of our first episode. So um, yeah, I'll uh I'm gonna do my hair a little bit different for that one since we'll celebratory since also. Celebratory things, yes. And we'll we'll break back out the video for that, I think, because it's a special occasion. Perfect. Yes. All right, till next time.
SPEAKER_01Thanks for tuning in to Joint Effort PAs. If you enjoyed this episode, be sure to subscribe, leave a review, and share it with a fellow PA or med-minded friend. You can also follow us on Instagram at Joint EffortPAs for updates and extra content. See you next time.