Good Raddest PA Bad Rheumatologist and Surgeon
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Hey everybody, this is Tina again with Good Nurse, Bad Nurse. Welcome back to another episode of this podcast where we use stories from the news about healthcare professionals to shine a light on the good and the bad that happens in our profession. So today I have a very special guest.

with me. Number one, he is a PA, a physician assistant. And I don't think we've had a PA on before. I could be wrong. I'm wrong a lot, but I'm pretty sure that I haven't had a PA on. And just as soon as I say that, somebody will email me and say, you did remember that one. And then I'm going to feel horrible. But I don't think we have had a physician assistant. I talk about

physician assistants a lot on the podcast, just whenever the topic of different types of providers come up. But I'm really excited to get to have one on the show today. For the good nurse portion, we're going to discuss the profession a little bit, maybe do a little comparing and contrasting to the nurse practitioner, to the nurse, you know, sort of counterpart, and just kind of use this as an opportunity to clarify what a PA is, how does the role differ from an NP,

And then just also talk about his social media presence because he has one. And he goes by The Raddest PA and he's here today to help me talk about these stories. Joseph, welcome to the show. Thank you. I'm so excited to be here and talk about some fun things tonight. Yeah, well, I'm really happy to have you on the show. We're going to use these stories to really kind of get the provider perspective on this. A

And so we're both just sitting here speculating sometimes if we're talking about a provider. Sometimes we just kind of have to speculate because we're not nurse practitioners or PAs or, you know, or medical doctors. And so I'm super excited to get your perspective on these stories. I also have a little bit of a, when we kind of get into the nitty gritty of the stories, I have a little bit of a personal story to share there.

that man really hit home when I found this one story. We've got two stories to do. One is about a surgeon and one is about a rheumatologist. And neither of them have a whole lot of details. So that's why I felt like I could fit in two stories because they're both relatively short as far as what all went on with them, but fascinating nonetheless and definitely something that's worth delving into and talking about

the problems and the issues that can come from this and the fear of the public from just even going to a provider. So super excited to get to talk about this stuff. So let's get started with this first story. This is going to be the story of Dr. Ian Patterson. Ian Patterson is a former breast surgeon in the UK.

So kind of going across the pond a little bit. I always love saying that whenever I get to talk about somebody from Europe. He was convicted in 2017 for performing. And you guys are going to this is truly, to me, body horror. This is

Absolutely horrifying to think that this happened. He performed unnecessary and harmful surgeries on numerous patients. His actions led to a 20-year prison sentence and widespread reforms in patient safety protocols. Thank goodness.

So he qualified in medicine at the University of Bristol in 1981 and began his career in Manchester before moving to the West Midlands, where he worked at various hospitals, including Good Hope Hospital in Sutton, Colville, and Heartlands Hospital in Birmingham.

So despite a suspension in 1996 due to concerns about his surgical practices, and that always just throws me. I've been doing this, Joseph, for seven years. I've been doing these stories week in and week out for seven years. And I swear I still am absolutely flabbergasted the amount of stories that I've done about providers, nurses, all kinds of health care people who were

investigated for doing things and then just kind of let back out on the public, let loose. And so he was suspended in 1996 due to concerns about his surgical practices. He was later employed by the Heart of England NHS Foundation Trust and also practiced at private hospitals run by Spire Healthcare. And I found out, so I love to read

And I read a novel. Yeah, I mean, I like reading all kinds of stuff, including just complete garbage. So I read a novel. It was about this couple in England who their children were like swapped at birth. And then like a couple of years later, they find out and there's all this stuff that happens around the situation. But that is how I learned like

like, because while I'm reading, and this happens a lot, I'll be reading a novel, I'm just like, is this real? And then so then I have to go look it up to see, does this really happen? So I did not realize because I knew that they had the National Health Service in England. So I just thought, oh, all health care is just through the National Health Service. But they also have private insurance. And I did not, I'm just so ignorant. I just didn't know that. And

This novel really kind of like it shined a light on that aspect of it, how they have like private hospitals versus the public ones. And I'm just like, well, that's kind of what about that? If you're not wealthy enough to be able to afford like or have good enough job or whatever, then you got to go to like the public hospital. And anyway, so he worked for apparently both as a surgeon.

And in 2017, he was convicted of 17 counts of wounding with intent and three counts of unlawful wounding relating to unnecessary surgeries performed between 1997 and

Remember I said 1996 was when he was suspended, and 2011, but it isn't until 2017 that he was convicted. Initially, he was sentenced to 15 years. His term was later increased to 20 by the Court of Appeal. That's kind of, that's different. So his malpractice involved performing a

unapproved cleavage-sparing mastectomies, leaving behind breast tissue that increased the risk of cancer recurrence. He also exaggerated or fabricated cancer risks to persuade patients to undergo unnecessary surgeries, including mastectomies and lumpectomies. Those procedures were carried out in both NHS and private hospitals, affecting over 1,000 patients.

Joseph, 1,000. That's insane. Patients. I can't even. When I read that, I was just like, I'm so, I almost just couldn't even believe it. Yeah. It doesn't, I was like doing the math going, is that even possible? Yeah. You like see these television shows like Grey's Anatomy and they do an episode on this and you're like, no, that's, you know, a television show. It's not real. But as recent as 2017, that's not that long ago.

That's crazy. You want it to be fake. You want to go, okay, this is nothing but fiction. This would never happen in real life. And as they say, the truth sometimes is stranger than fiction. So the victim suffered significant physical and psychological harm, as you can imagine. For instance, Frances Perks underwent multiple unnecessary surgeries, including a mastectomy.

Based on his false diagnoses, another patient, Jade Edgington, had several invasive procedures between the ages of 16 and 19, later discovering they were unwarranted.

Oh, my gosh. An independent inquiry in 2020 revealed systemic failures that allowed Patterson's malpractice to continue unchecked. The report highlighted a culture of avoidance and denial within the health care system with missed opportunities to stop his harmful practices. It recommended recalling all 11,000 patients treated by him for review. Of course. I mean, if I was one of those patients, I would be going, I want my case reviewed for sure.

There was a 37 million pound compensation fund that was established for Patterson's victims with contributions from Spire Healthcare, the NHS and his insurers. But despite this, many victims continue to seek justice and advocate for further accountability. What do you think about this? I mean, what did you think about this when you read this story the first time? Just like you, I was shocked.

And the fact that it's just happened only a few years ago made me even more scared. I mean, I've been working in healthcare now for a long time and it makes you kind of question your own reality and who you're working alongside with. And, you know, this is,

somebody that could be someone that you knew you know this could be someone that you've worked with before well it's just really kind of puts your entire reality on its head and makes you question things and it's scary because we all get into this for you know good reasons usually to help people this is the exact opposite so it really kind of makes you question everything and makes you think like these are the the people that make our health care system

the bad parts of our healthcare system. And it makes people question getting help and it makes people question their providers and it makes people, you know, not want to go seek necessary medical attention. So it really just is so damaging in so many ways.

Have you ever heard someone say, as a nurse, I probably hear this maybe, I don't know, maybe more than maybe a direct provider would, but I feel like at the hospital, my patients would just be like, that doctor's just prescribing that, blah, blah, blah, probably getting kickbacks. They just say things like that. And as a nurse, I'm just sitting there thinking, you don't really think that. That's

That doctor is, I promise you, that doctor or that PA or that NP, they are not getting anything from this. They have no, you know, they don't have a dog in this hunt, as they say. But then you read something like this and you're just like, oh, my gosh. And working in a hospital, it's going to be different. It's a little different there.

Depending, I mean, if you're talking about a shift, because physicians and PAs and MPs, they're shift workers sometimes in hospitals, not all the time. If that's the case, there is no, there's, you know, probably not as much of something like this that could happen necessarily. But at the same time, if they're coming in for consult and they do have a practice where they are making money based on how many patients they have, they're making money based on how many surgeries they do, you know, that sort of thing.

It happens. You know, there's always nuances to all of that. I mean, in the ice use specifically where I work, you know, it,

My page doesn't change if I see one person or 500. It doesn't change if I do one procedure or 500. It's the same across the board. But then, like you said, on the other hand, I know there are specialties that are kind of RVU-based. So that really calls into the person's personal ethics about

what they do to move that needle one way or the other. And, you know, you want to believe the good in people and you want to believe that everyone's doing the right thing and just doing what's necessary. And I think probably in most cases, that's the truth. But then you have something like this where, you know, they go against what everything else we stand for in healthcare. Years and years ago, I worked for a neurosurgeon in Nashville and he

He was very conservative with his diagnoses. He really believed just

ethically and morally, he believed in taking a conservative approach when it came to surgery. And so he would not do surgery when some other neurosurgeons would or orthopedic surgeons would do surgeries. And it really frustrated him a lot because he would end up seeing patients who had been through surgeries from different

surgeons and he would, you know, maybe look at their past films or however he would determine. And he would just think I would have never done the surgery on this patient, but there was sort of a gray area there where you could justify doing the surgery and,

It's just not necessarily what would have probably been best. You know, double down on the physical therapy. Really, you know, try to give it time because in reality, you're ultimately down the road going to be worse off if you go through the surgery. You might get some immediate relief, maybe. And

I was just a receptionist. I was not a nurse or anything medical whatsoever, but I remember watching him and just being really impressed with just the ethics of how he believed. And then also being horrified that there are surgeons out there who don't necessarily take that path. And they go, well...

I can have a bigger house and have a vacation home and I can have this and that if I do lots more surgeries. And I'm just like, oh, this is not misdiagnosing. There's like a fine line, I guess. And something else I think about on that topic is everybody practices medicine differently. Even if they are in the same specialty, you're kind of a product of your education, your experiences. And

the same diagnosis could be gotten to a hundred different ways. You can treat a certain diagnosis a bunch of different ways. And I see that specifically as a physician assistant because I work with multiple different physicians and they all do things a little bit differently. And some do things one way where...

I might not necessarily agree that my experience is something different, but it usually ends up working out. And that's just their experience and what they want to do. So there's a lot of different ways to do the same thing in medicine. And I think that's why we call it practicing medicine. Everyone's just practicing. Some people are more experienced than others. Some physicians that are 20 plus years practicing may have a different take than someone that's just at a fellowship or just

And that doesn't necessarily mean it's better or worse. Sometimes new people right out of school have the most up-to-date literature. And the physician that's been practicing for 20 years hasn't quite read that yet or been that up-to-date. So it can really go either way. But I say all that to say there's...

a million different ways to do the same thing in medicine. And sometimes that might be driven by something with a little bit more malice, but it also might just be people doing the best with the information they have at the time. And it's just what they think

Yeah. And I think sometimes patients also can drive with some providers, patients can drive what they do and they, you know, they'll shop around until they find somebody that's, that will cut them open. They'll shop around, they find somebody that will prescribe whatever it is that that antibiotic that they just insist is going to cure their cold. You know, they're,

they have it in their head what they need and they're going to find a provider that's going to give it to them. Yeah. And nowadays when patient satisfaction scores are so important that, you know, you don't give an antibiotic for a cold, you might get a bad review and that kind of affects your job. So it's, yeah, like you said, it's a fine line. It's difficult. Every situation is very nuanced. Yes, absolutely. Absolutely.

So, inquests into the deaths of patients treated by Patterson have been ongoing, with 62 cases examined as of October 2024. So, they are still looking into this. These investigations aim to determine whether his actions directly contributed to patient deaths potentially leading to further legal consequences for

The cases prompted significant reforms in patient safety protocols within the UK healthcare system. Recommendations include improved communication with patients, stricter oversight of surgical practices, and the establishment of a public register of surgeon credentials to prevent similar incidents in the future.

I think a lot of people are afraid to like maybe get a second opinion about things because they don't want to offend their doctor. Like they're afraid if they say, can I go get another opinion?

You know, well, do you not trust me? How do you feel about that? Do you think as a provider, and I know you work in an ICU is a little different, but how do you feel about that? If you were, say, if you had your own practice and you were just seeing patients and someone was just like, well, I don't know, can I get a second opinion on that? How would you feel about that? Yeah, I say more power to you. I empower patients to be able to be their own health advocate as much as possible.

And we do get that a little bit in the ICU where patients will be like, I want to hear this from a different person.

provider. So we do, we will in that case get like a second opinion. So I've, anytime I've come across it, I'm always like, yeah, but why not? You know, it never hurts. And then the patient can make the best decision with the information they've been given. You know, nowadays we are very patient centric in healthcare and that's how I was trained and that's how I practice. So, you know, I often think what would I want as a patient or what would I want for my loved one

as a patient. And I am very pro, if you feel uncomfortable or if you were just not sure, I don't think it hurts to get a second opinion and then make your decision based off of those choices. How many times have we been told we're the eyes and ears for physicians, for providers? So I cannot emphasize to you how incredibly happy I was when I discovered Echo. With Echo, you can hear without

absolute precision. It doesn't matter how noisy it is because it amplifies the sound up to 40 times. And the screen on the front of the device shows the pulse and a waveform. It's unlike anything I've ever seen before. When I was brand new in the cardiovascular intensive care unit, learning how to take care of open heart surgery patients, ECMO patients, balloon pumps, and pellets, all those things, those rooms for those patients can be extremely noisy. But

But I didn't have to worry about it. Being able to hear those heart sounds and lung sounds was so important, and it just wasn't a problem. In fact, doctors and nurse practitioners and PAs would literally come up to me and try to get my stethoscope because you're going to be able to detect diseases earlier using this device, using the app that goes along with it. It's like having a cardiology consult right there, a second opinion right there at your fingertips. You can also record the sounds that you're hearing and even see an ECG.

So if I think I'm hearing something and I'm not sure, I can just record it, send it over to the provider because the AI gives you a detection flag for AFib and a murmur. I get so excited when I talk about Echo because it really was such a game changer for me. In fact, I trust Echo so much that I worked with their team to create a special offer just for our listeners. Right now, you can get $50 off plus a free customizable chest piece, cover,

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The next story that we're going to talk about is Dr. Jorge Zamora-Quesada. He was a rheumatologist based in Texas, and he was sentenced in May of 2025, this is a brand new story, to 10 years in federal prison for orchestrating a nearly two-decade-long healthcare fraud scheme. His actions involved falsely diagnosing patients, including children with chronic illnesses like

rheumatoid arthritis leading to unnecessary and harmful treatments. The scheme defrauded the government, well, government and also private insurers of over $28 million and involved more than $118 million in false claims. And I can tell you right now, after, as I said, I've been doing this for seven years, I've been doing a lot of these stories, but

One of the worst things that you can do as a healthcare provider is to do anything to defraud the federal government. They will be on you so fast. Man, it's like you do not want to be on their radar because I've also done stories where they've like come in guns, literally guns blazing to clinics who prescribed opioids and drugs.

And there are a lot of those that it was justified that they did that because they were definitely overprescribing and it caused a lot of deaths and this huge opioid epidemic that we have. But some of them, I've done some other stories where it's just like, man, you don't want the federal government on your radar. So I'm just like, I don't know how bold you think you are. I mean, for someone to do this, you are just asking for trouble and it's,

This guy was just, I just, I can't get over it. So from 2000, the year 2000 to 2018, over 18 years.

He falsely diagnosed numerous patients with chronic conditions administering unnecessary treatments such as chemotherapy and toxic medications. They were aimed at defrauding insurance programs like Medicare, Medicaid, Tricare, and Blue Cross Blue Shield. I'm assuming Tricare is like the specific state-based government insurance, I'm assuming. So in 2018...

They indicted him and revealed that he had submitted over $118 million in fraudulent claims and received more than $28 million in payments. The indictment detailed the extensive nature of the fraud and its impact on patients. And so after a 25-day trial, 25-day trial, he was convicted on multiple counts, including conspiracy to commit health care fraud and obstruction of justice, and

testimonies highlighted the severe physical and emotional harm inflicted on patients. And he was sentenced to 10 years, as I said, in prison and ordered to forfeit over $28 million in assets, including 13 real estate properties, a private jet, and a Maserati. Just the absolute gall of somebody to think they could get away with something like this, but then also literally physically making people sick when there wasn't anything wrong with them to begin with.

I work as a transfer coordinator. I actually speak with providers on the phone a lot because they will call from like an ER and say, hey, I need to transfer my patient. We don't have the ability to take care of him here at this hospital. We need a higher level of care. And so then I'll call another hospital and get the providers connected and let them talk and then, you know, just help coordinate that transfer.

And one thing that I can tell you, because I work with hospitals all over the country, is there is an absolute shortage of certain physician specialties. And rheumatology is one of them. It's...

You know, and a rheumatologist is not somebody that, you know, you're going to be trying at three o'clock in the morning to find a rheumatologist. But at the same time, there are lots of physician specialties that that you cannot you're going to go hundreds of miles. And it is one of those specialties that if you especially live in a place like Arizona, New Mexico, kind of, you know, out west, you could go hundreds of miles out.

hours and hours away from your home to try to get one of these specialties. So then to find out that this person is like, I just can't believe that it's necessary, but I guess it was. I mean, I don't know. And I know that some of these medications are probably really expensive and I don't know how somehow he's pocketing the money for it. I don't know. It just blew my mind, Joseph. Yeah. Another really scary, scary case. And you're right with the rheumatology. It's such a scarce, I feel,

profession. It's not only that, but it's very difficult to understand. I think a lot of healthcare people would probably agree with me in saying that like just rheumatology as a general rule is convoluted and very, very, very nuanced. And the labs don't necessarily mean anything. And there's 101 of them. And that every day kind of internal medicine is

provider is it probably doesn't have a lot of experience with it plus then you throw on there that the more rare diseases that you really need someone that is very specialized so not only are they not very readily available but it's such a vulnerable population that is looking for answers sometimes and and hoping that they're going to find answers in this rheumatology field but

This podcast is sponsored by Talkspace. You know when you're really stressed or not feeling so great about your life or about yourself? Talking to someone who understands can really help. But who is that person? How do you find them? Where do you even start? Talkspace. Talkspace makes it easy to get the support you need.

Talkspace is here for you.

Plus, Talkspace works with most major insurers, and most insured members have a $0 copay. No insurance? No problem. Now get $80 off of your first month with promo code SPACE80 when you go to Talkspace.com. Match with a licensed therapist today at Talkspace.com. Save $80 with code SPACE80 at Talkspace.com.

They may never find one. They may never find a physician to take care of them. And it's a wild field. Rheumatology is a wild field. Yeah. So when I told you guys I was going to tell you a little personal story. So I'm talking like 15 years ago or so. I went to my primary care just for like

regular checkup. And so they just drew labs and they came back and was like, um, this ANA is kind of elevated. I'm going to send you to a rheumatologist. And I remember just being like, what does that mean? Because I was before I went to nursing school. I really did not know. And so I went and this rheumatologist that he sent me to, first of all, I got an appointment like right away with him. And

He did all these tests, but he immediately diagnosed me with psoriatic arthritis. And I had never heard of this before. I was not having any symptoms. I did not have any psoriasis on any joint area or whatever. I did not even know what in the world it was. And he looked over my entire body and then just looking at the bottom of my feet,

And I don't know, maybe I needed a pedicure. But he was just like, I don't know what else he could have been. There was just nothing for him to go on that he diagnosed me with psoriatic arthritis and prescribed medications for it. And I didn't want to take it. And so I left there.

I ended up getting a bill for like $800 because one of the tests he did was like some kind of genetic testing that I guess my insurance company thought was unnecessary. I am sure I agree with them. I don't think it was necessary, but I was not going to pay it. I was like, I'm not paying this. And they were like, well, you know, the testing, the lab company was just like, well, your doctor ordered. I'm like, I don't care.

I did not approve this and I would not have approved this had they told me, you know, hey, we're going to do this test that costs $800. I didn't pay it and nobody ever came after me. So I'm still sitting here to this day without, you know, being put in jail or anything. But I didn't pay it. Normally I pay my bills, but I was just like, I'm not paying this on principle. But then I went back to my doctor. I was like, I don't want to take this medicine. This seems stupid.

He said, well, let me send you to a different rheumatologist. So then I had to wait months to get into this other guy. And he basically was just like,

why are you here? And he goes, are you having any symptoms? And I said, no, I told you my primary care doctor, there is an elevated lab. And he was looking at me like, that's silly. Well, to me, it's not silly. What if I have some disease? Well, obviously I understand now that that's ridiculous, but why didn't my doctor understand that that was ridiculous? I don't know. This

This is horrifying to me because if I could have easily just if my spidey senses had not been tingling and I had not, you know, kind of had that sense of like, I really don't want to take this medicine for psoriatic arthritis, which now I understand like I didn't even have.

It's insane. I don't know. Every time I think about it, I'm just like, what in the world? Where is that guy now? Is he like living? Does he have a private jet somewhere? What is going on? It didn't make any sense. No. So this is the sort of thing, as you said earlier, that...

A lot of times, especially on social media, as you know, on TikTok, on Instagram, on different social media sites, you have healthcare professionals, whether it's nurses, doctors, PAs, NPs,

And sometimes I feel like most of the time people are really cool about it, but sometimes they'll like put these, I feel like are kind of rude. It's kind of like rude commentary about their patients who are kind of giving them some pushback, you know, like, Hey, I Googled this. And they'll say things like, well, you know, you know, your, your Google search does not equal my medical degree or whatever, which I get that.

But at the same time, people have the right and I feel like should, you know, try to learn as much as you possibly can about whatever disease process maybe your your health care provider is kind of leaning toward. Like, hey, it looks like you may have lupus.

Well, don't you wouldn't you want them to then go look up everything you could possibly find and learn all about lupus or diabetes or whatever it is and learn about it and then ask questions. But some people say, I don't know, some health care people get offended, appear to get offended by that. What do you how do you feel about that?

You know, the average lay person doesn't understand the majority of medicine. It's, there's a reason why we go through so much medical school to be able to do what we do. It's

It's very complex in a lot of ways. And the average person can't be expected to know all the ins and outs of every disease process. That's just unreasonable. So I always encourage people, especially my friends and family, to ask questions. And if anyone is giving pushback to that, then they need to really take a look at their own practice and have some insight into maybe there's something else going on that's causing them some burnout. Because

Half of our job is patient education, and we need to give patients the information so that they can make decisions that they feel are best for them with our guidance. I always say, you know, you're driving the bus. I'm just trying to give you some directions.

And, you know, if ultimately you decide something, if I think it's reasonable, I will support it. But other than that, I don't think that people should be shaming patients for not knowing. It's not their job to know. It's our job to educate them. And I often think for people that don't have somebody in their life that understands a little bit of medicine or can kind of decode it, they're at even more of a disadvantage. At least like my mother, for example, when she's going into a hospital

doctor's appointment. I want to be present because I want to understand what's going on and also help her. And I can do that in a way that I feel comfortable. But if I chose a different route, if I wasn't in medicine, I wouldn't know any more than she did. So it's really a tough situation when people just don't know. And that's where problems like this flourish, where people can get taken advantage of. Because again, it's a vulnerable population that's looking for help

And you walk in with a white coat, that's automatically giving you some sort of credibility and trust and people trust you. And you shouldn't just throw that away. You really should respect it. And a whole other topic of like people doing that on social media, I think is so taboo. It's a terrible thing to do.

Putting your work online in that way or talking about patients in any way, I think it's just tasteless. And people have gotten fired for it. People have lost their jobs, lost their careers. I know people personally that that's happened to. So if they're not learning from that, it can happen to them just like, you know, these patients, terrible things from different providers can happen to them.

It's not the right thing to do. And it's probably discouraging people from asking questions. So it's just a circle of, of distrust that's being bred by these behaviors. So I personally, again, always tell people, ask questions. There's no question too big, no question too small.

And sometimes it takes multiple times to understand something. So if you need to think about it, digest it, write a list of questions later so when you follow up, you have those questions written down for you. And the opposite could be said that in a clinic specialty, especially when you're seeing multiple patients a day, you might be kind of rushed and you don't really have the time to sit down and explain everything. And that probably is true. But again, to do best by each patient is

You have to have the time to explain things to them. And, you know, people do the best with the information that they have at the time. I always say that. Dr. Google is a thing, you know, or I call it Google PAC. People look for their answers where they can if they don't have someone credible to ask, is this right? And so although that's a little bit of a double-edged sword,

it can at least maybe open up a door for questions, give them a little bit of information to just open the door of asking questions. And maybe it's wrong. And a lot of times it is wrong. But at least it gives them something to start a dialogue with. I think that when we're, especially from a nurse's point of view, and you're in the hospital, you have multiple patients or very sick patients. When I worked in CVICU, and I would have one or two very sick patients, and you have a family member who's

questioning what you're doing, why you're doing it. And what I'm doing and why I'm doing it is totally dependent a lot, mostly on the providers and what they are ordering. So, but they're usually they will question the nurse and not the provider. They'll wait till the provider's gone and then they start drilling you. And you're just like, why didn't you just literally say that to that person that was just here? Because, oh, I kind of have to hang these antibiotics and then go next door. But, you know, the

The thing is, if we could just like take a minute in whatever capacity that we're working at as and realize that if they are to me, whether it's family or the patient, but especially the patient, if they're able to, if they're if they've gone as far as trying to Google information and they have something presenting to you, they're at least trying. Because one thing that's very frustrating as a nurse is to see patients continue to come back into the hospital.

because they were not taking, you know, their stent clogged because they weren't taking their Plavix or their, you know, Effian or whatever it is they're supposed to take. And, or their, whatever Medicaid, you know, they're in hypertensive crisis because they were not taking their, their blood pressure medicine, or they thought they were just taking it when, when they thought they needed it or whatever. They're just like completely not

educated about the importance of taking, you know, or they had a stroke because they weren't taking their Eloquus or, you know, and they just didn't understand because they, for whatever reason, you hope that the provider did every, the providers that, you know, led up to whatever them being discharged from the previous admission, you would hope that

that somebody was trying to educate them and they sent them home with information and then somehow it just disconnected and they just didn't understand it. And they end up back in worse shape because they just did not understand the importance. And this is a whole other thing of whether they could afford the medicine. That's a whole other issue. But I'm talking completely different, which is also frustrating. But

I'm talking about the ones who literally just did not understand. That is so frustrating. I would much rather have somebody who's asking questions and trying to understand, and then you can maybe go, oh, I love that you looked that up, and let me take that information you're giving me, and let me go do a little research and see if I can come up with a good answer for you, or let me see if it's something maybe the doctor needs or the PA or the MP needs to talk to them about to try to help explain. I would much rather...

have something like that, then them just sort of like not saying anything at all, not questioning anything at all. And they're literally just leaving no clue about their disease process, no one, no understanding whatsoever of what is truly going on and how whatever, you know, the next thing that ends up bringing them back into the hospital could have been a hundred percent preventable had they just, you know, understood how important it was. Sometimes people are afraid to ask questions. Mm-hmm.

Yeah. It's overwhelming. There's so much, there's so much, sometimes we know so much and we just talk and use words that are just, which you're trying to talk on that third grade, fifth grade level, whatever you're supposed to use with people. But it, you forget the stuff, you know, that you didn't know. I mean, I, when I went to nursing school, I learned so much. I remember thinking, this is like a completely different language. I can't, I'm too stupid to do this, but

But then you just learn, you start learning and you just, as you start layering on that information, then it becomes second nature and you just, you get it, you know? And there's like this whole way of seeing the body inside and out that you never saw before. And it's so easy to forget that when you're talking to patients and family members. Yeah. It really is completely different language.

And then we talk to each other in medical jargon. And let's not even get into the abbreviations. The abbreviations is a whole other sub-language. And then, you know, you accidentally say COPD to a patient, for example. And they're like, yeah, yeah, I have that. Whatever that is. Yeah. It means absolutely nothing. Yeah. Yeah.

Well, I guess that kind of wraps it up for the bad nurse segment. I would like to shift over into the good nurse segment. And we're going to talk about you as a PA, as a physician assistant. And any chance I get, I try to educate people on the correct way of saying physician with no S, assistant assistant.

It's not a physician's assistant. And I still see people do this all the time. It's so common to say physician's assistant. And I think just it's,

in the name to just assume that you're just sort of an assistant to the physician, like the assistant to the regional manager. But that is not at all. That's not at all the role. That's not at all. It's just it's very different, I think, than what the name says. And you have a real pinned on your TikTok account.

talking about how some organization, forgive me, I don't remember what it was, which one it was, but back in 2021, I think, was talking about trying to change the name of physician assistant to physician associate. Do you want to talk about that a little bit? Yeah, it's kind of a movement that's been happening, and it's quite a controversial one. And for us, I think, I can't speak for all of us, but I think that

The underlying message there is that physician assistant is kind of a misnomer. And like you said, it kind of makes sense to say physician's assistant, I think grammatically, but then it kind of gives patients an inaccurate representation of what we do. And for the sake of education, you know, educating people like we've been talking about, it's also important for people to know what we do so that we can help them properly.

And so you're right. We're not an assistant. We don't like follow physicians around with a clipboard. We really do a lot of things independently, but ultimately in collaboration with the physician. We have a, in most states, we have a collaboration agreement, which is what I prefer, what a lot of us prefer. We want that collaboration. We want that partnership. We want to work in conjunction with not only the physician, but the entire healthcare team.

But given that assistant is kind of a bit of a misnomer and it makes people confused, there's been a long, long, long, long conversation and dialogue about changing our name. And there was a big vote and, you know, they had some very interesting and unique options. But ultimately, the AAPA, our American Academy of Physician Assistants, kind of our governing body essentially decided, you know, it's time to make a name change and they chose Physician Associates.

And I think kind of academically, if you kind of look at assistant versus associate, those do come with different academic educational backgrounds. So although I don't know if it's the perfect name, some people really enjoy it. Some people like it. They prefer it.

And I see more and more people adopting it. Now, it has to pass every state to become official. And the only state I believe to date that it is official is in Oregon. So they can legally introduce themselves as physician associates. Still everybody else in the United States, it's physician assistants. So the idea is that it will eventually move there. Now, I said it's controversial, and it really is, because I think

Most of us probably care to a degree, but it's not like an end-all be-all. But there are lots of people out there in the medical field that look at our profession and kind of say you want to be physicians or you're trying to be physicians. And that's just truly not the case. It's not the case at all. You know, I can't speak for everyone. There's always going to be, you know, a

like these doctors that we talked about earlier in the episode, there's always going to be someone that outlies that goes against what most of us believe. But I would say the majority of us just want to be recognized for what we do so that we can fit into the healthcare model. And really, at the end of the day, bring patients the best care possible, fill gaps in healthcare, get more access to healthcare for some patients. You know, a majority of us work in primary care.

And we all know how hard it is to get a good primary care provider or just get in at all. So, you know, there's a role for us if there wasn't that we wouldn't exist. But as far as the physician associate, it really is just kind of like a name change to really give patients a better idea of who we are and what we do. I do think that with younger generations, it's probably going to be less of an issue. I think more and more people are

becoming more comfortable with nurse practitioners and PAs, what is commonly referred to as mid-levels. I don't know how you feel about that title. I'm not in love with it. It was very commonplace to say that, and a lot of people still do. And I don't think a lot of people say it with a negative intention. But again, with really language in any form, it evolves, it changes.

And that's also something that if you look at it for what it's saying is that we practice at a mid-level is what some people can interpret as. And truly, I don't think any of us would agree that we practice at a mid-level. That would be weird to say, oh, I'm going to go see someone that only just practices at a mid-level. Nobody wants that. I don't know that I would want someone that's just like

halfway doing medicine. So it's moving towards the advanced practice provider or APP, for example, is again, just a nomenclature thing to better accurately represent what we do.

Some people are staunch and still calling us mid-levels. There was another video of mine that I think made it to the wrong side of TikTok that I got a lot of comments that weren't very kind. But ultimately, it's really just about clarity. Yeah, I saw, I can't remember, it's been a while ago that I saw someone talking about the term mid-level and they did not like the term mid-level that...

they didn't like the term provider. Like, I don't know, there was just this whole thing about calling, I use the term provider because you can use it across all providers. You don't, you know, you don't have to be, because people will say physician or doctor and mean everyone. And I do that sometimes too. I mean, if I say doctor, I'm talking about a provider, but I've tried to, especially as a transfer coordinator, I deal with nurse practitioners, PAs, and

physicians, MDs, DOs, all different types of providers. So it's just so much easier to say provider. And apparently that's offensive too. So I'm just like, you can't get away from being offensive. There's always going to be someone that's offended by something you say or some, no matter how hard you try.

what I think is really important is that people understand. And I just try to use this platform as often as I can to just remind people of this. Um,

No matter the provider, whether it is a physician assistant, a nurse practitioner, a medical doctor, doctor of osteopathic medicine, whoever the provider is, it is about what they have put into their education and how much integrity that they have to carry out to practice medicine. And because you can have, I've done stories about doctors.

We just talked about two medical doctors, right, who just chose to completely misdiagnose on purpose people just for financial gain. I've done stories about NPs who were convicted of misdiagnosing.

misdiagnosing someone accidentally, and yet they lost their license because it ended in a death. But it has nothing to do with the type of provider and everything to do with, number one, people are human beings who are going to make mistakes. That's just going to happen. And I don't care what degree you have or how much education you have. People will make mistakes. But number two, it also has to do with how

how much effort you've put into your education and understanding your patient population and your disease process that you're responsible for. Yeah, absolutely agree. And one other thing that we get a lot of flack for from the PAMP standpoint is I feel like it's hard for people sometimes to believe that

that we didn't want to go to medical school. And I think the provider thing comes in play where physicians really don't like that work because they don't want to be lumped in necessarily with us, which I can understand that to a degree. I mean, they went through a much...

harder training. They went through a much longer training. They are the specialists and we don't try to be the specialists. I think at the end of the day, like you said, it's just everyone's trying to do what's best for the patient and you can't please everyone. Everyone's going to have an opinion. And, you know, I just try to just ignore that and just do my job.

The thing is, you can have a physician that went to, you know, got their bachelor's degree, went to four years of medical school, did their residency, did a fellowship, you know, spent 10 years studying.

going to school and then just kind of like skirt through and not really care. I've worked with physicians like this. You can tell they just don't care. It's not often. I mean, I don't feel like this is... It happens a lot. I feel like most of the time people do care. But I have come across physicians who were just like... I'm just like, do you even care? Or why are you even doing this job? Please go get a job somewhere else. I just...

You don't seem to care about your patient. And if I would rather have someone who got, you know, went to two years in PA school or, you know, four years in nursing school and two years and, you know, whatever the equivalent, I think both do six years ultimately total. But I would rather have somebody who did that and, and then continues to educate themselves on their specialty because that's, you ultimately have to do that. I, I,

I've talked to nurse practitioners who have said, you don't really know what you're doing when you get out of nurse practitioner school. You have to work alongside another nurse practitioner or a physician and learn how to, quote, practice medicine and learn how to do your job, but also just continuing to educate yourself on that. I think that

And the same thing is with nurses, you know, because when I got out of nursing school and started working at the hospital and started taking care of patients, I just remember being very overwhelmed and just feeling like, oh, my gosh. And I was very task oriented. I was very just kind of like doing what I needed to do. And just I just didn't I didn't really understand it. I mean, I just was overwhelmed. And it took probably like a year.

of

I would go home and just be like, Oh God, I just had this patient with this or that. I would just read about it. I was constantly trying to educate myself. I got certified in progressive care because I did progressive care when I first started. And then I got certified in critical care nursing when I transferred to the CBICU. And I was always wanting to just like understand more. And I feel like if you, it's, it's what you put into it. You know, if you don't do that,

you can get away with just kind of like going through the motions and do any job is like that. So I just, I just feel like it is whatever the person is putting into it, whether, you know, whatever kind of provider that you are, which by the way, I wanted to ask you, what do you, so what do you know the differences to be between a PA and an NP? Because they're both very, very similar as far as just like,

Right. Like your scope of practice. Yeah, it's very similar. There are some some differences, but by and large, pretty interchangeable in most situations. Like, for example, in in my hospital, my ICU room.

there's not really any difference. We're all lumped under the same APP umbrella. We all are hired for the same job. We all have the exact same scope. We all do the exact same thing. Other than the two letters that come after our name, there's really no difference.

There are some training differences and backgrounds, I think, is where probably the most of it lies, is that nurse practitioners have to be a nurse before. And physician assistants, although you can be a nurse and go to PA school, you're generally not. So as far as like the preschooling of the education is a bit different. I think another big difference is that nurse practitioners in a lot of states don't need a supervising physician to practice.

And I would say the majority of states physician assistants do. So that's another kind of main difference between them. So for example, in Oregon, where I used to live, nurse practitioners can practice independently. So they can open their own practice. They don't need a collaborating physician. But that's not the same for physician assistants. So that's another, probably one of the bigger differences also. But by and large,

Other than those things in the real world, clinical world, it's very, very similar. Someone explained it to me as nurse practitioners when they go to nurse practitioner school. And I'm not an MP, so I don't know. I just know going on what people have told me that they...

Even nurse practitioner school is based in nursing theory. And so you're becoming a practitioner of nursing as opposed to, so you're studying the medicine, but from a nurse's perspective, and PAs are more from a physician's, which it's literally in the name, but you're more from a physician's, like a medical perspective.

And I can see that as a nurse working. I've because working in ICU, I've worked alongside PAs. I've worked alongside NPs. And you can definitely see the difference in the two in the two, just like the way that they talk, the way that they handle themselves. Just it's very, very obvious to me the difference between I can I can spot them immediately as soon as I start. I don't have to see the letters after the name. It's very obvious to me.

I don't even know how to explain it, but there's just a way of the way that they address the patient, the way that they address a problem even. I'm not sure I even know how to explain that. But all I can say is that PAs remind me more of doctors than nurse practitioners. NPs remind me more of nurses who've just gone on to become a nurse practitioner. That probably makes no sense to you. I don't know. It's interesting to hear. Obviously, I don't have the same perspective as you, but that's really interesting and even kind of cool to see that.

the differences. But I would agree with you. I think that's a very common differentiating factor is nurse practitioners are trained with the nursing model. Physician assistants are trained by the medical model. But at the same time, medicine's medicine. Like you mentioned before, it's really about what you do with yourself after you graduate. Because even regardless of where you graduate from,

I mean, you may at one institution, you might be trained a little bit better, whatever that might look like. But by and large, it's a lot of on the job training. And if you are trained well on the job, if you have a mentor or if you go into a position where you have good oversight and you're trained really well, I mean, that's really where the rubber meets the road. And that's really where you're going to become either really good in your field or not.

You know, you might be given a little bit of tools in school, but by and large, it's really, like you said, what you do after and how much you put into it and how much you try. Yes, absolutely. Absolutely. And I really appreciate PAs and NPs and MDs and DOs and everybody that does that job because especially in this day and age, in this post-COVID era that we're in,

It's kind of scary out there. It's kind of scary out there when it comes to health care and getting good health care services, just get the resources. And I know you're in critical care, but man, when you talk about the specialties, it's horrifying. It is horrifying to think someone needs a certain specialty of medicine and it's just not there. I'm sorry, but it's just not there. And you may literally die waiting.

To have something, you know, taken care of. I hate to sound like an alarmist. I'm usually not that person. But working as a transfer coordinator, I'm sorry, I just see it too much. I see patients literally waiting in hospitals to transfer somewhere that has a resource, you know, that they need.

And it's, I don't know, it's kind of scary. Also, I see ICUs and regular beds too, but definitely ICUs and step-down units full all the time in hospitals. Yeah. Certain times of the year are worse, like winter and flu season.

for example. But we all have our role. And that's what I think makes medicine so great is that, you know, we need the specialists. We need the physicians. Obviously, we can't practice without them. We need the nurses. Obviously, we can't practice without them. And I think we fit really nicely to kind of just help and fill in the gaps where we can and just bring a little another level of

of experience. And healthcare works best when everyone works together. And some people lose the sight of that and they get caught up in what comes after your name. And, you know, at the end of the day, we can't function or give good care without everybody in the healthcare system from front desk to, you know, environmental services. So I think people forget that. Yeah, I think it's easy to forget it. And people definitely need to be reminded. I know just from

you know, when I even just having other people that do even what you do, like working as a bedside nurse and there aren't enough nurses that want to work at the bedside. So then you end up with three CVIC patients instead of two, you know, or one. We really should have one depending on, you know, whatever's, you know, going on with that patient. And, oh, well, sorry, we've got to give you another one, even though.

you know, you're doing targeted temperature management on this patient. Can you just like get them settled and then run next door real fast? You know, just something insane like that. And then at the same time, there's no one sitting at the desk. I'm sorry, the health unit coordinator called in. So if you happen to hear the phone ring, could you just go ahead and answer that while you're taking care of your targeted temperature management patient or, you know, you're

other patient with who knows, I tell you nurse bedside nursing is just not for the weak hearted at all. But if you, it's not, and it's not just the nurses, it's like all of the resources around, you know, that, that really make or break the whole experience. And yeah,

As you said, we need everybody working together as a team. Absolutely. Your TikTok page, do you want to just talk a little bit about that? Why did you start that? What made you want to just get on social media? And did you have any kind of passion about it? You know, it really started around COVID time. And I remember when TikTok first came out and I was like, I'm too old.

to be on TikTok? Like, no. But then one of my friends convinced me to download it. When you're at home during COVID, you don't have very many interactions with anyone. You can't go out. You can't do much. You're at home most of the time, you know, binge watching Netflix and eating takeout. But I just downloaded it. And I was watching the videos and it was making me laugh. And it was taking me away from the severity and the reality of what was going on out there in the world. And

I was like, well, you know what? I can, I could probably make a, let me make a video and maybe see kind of if I can make someone else laugh. And slowly but surely my videos resonated with people and the social aspect of social media in a time where, you know, you can't go outside really was so important and made me feel kind of connected to people again and built like a little community and, um,

just kind of kept going. And when people would message me and say, you know, this video made me laugh today, or this really made my day, or I needed this today, is what continued me to keep doing it. And really is why I still do it today. You know, making people laugh, giving them a second to just breathe from the terrors of the world, escape for just a moment. And if I can be part of that for somebody, then...

That's pretty awesome. That's great. I mean, that's the perfect answer. I mean, that's the good side of social media, I feel like. That's what you would hope it would all be, and it just turns toxic so easily sometimes. But yeah, that's the...

the reason that if I ever get on social media, that's the reason I'm usually watching cats and booktube or people talking about books because I'm trying to get book recommendations. What else do I need to read? Um, yeah. So my, my, uh, algorithm knows what I want to watch. It knows how to get me, get me hooked because it's showing me cats all the time. I just watching cats. Yeah. Well, thank you so much for coming on the podcast and talking about

All these really interesting and important topics. I really appreciate it. Yeah, I appreciate you having me on. This was wonderful. And of course, you guys can find Joseph at The Radist PA. Are you only on TikTok or are you on? And Instagram. Other. And Instagram. Okay. The Radist PA. And you can find me at GoodNurseBadNurse. And you can send me an email if you want to at Tina at GoodNurseBadNurse.com. And of course, I always have to remind you, even if you're a bad girl or a bad boy, be a good nurse.

And a good PA. Just be a good person. How about that? Yeah, how about that?