In Practice: Reflections from NPs and PAs

August 18th, 2016

The Caregiver Conundrum

Charity Maniates, MSPA, MPH, PA-C

My patient’s daughter, Jane, sits tensely on the edge of the wingback chair. Leaning forward slightly, her body, like a jack-in-the-box, stays seated, and she fires the question, “Do you really think my mother is ready to come home? Is this safe?” Rippling beneath her intense body language and direct questioning is a pervasive fear that […]

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July 13th, 2016

Running Through Life

Charity Maniates, MSPA, MPH, PA-C

The morning air has a chill, but pockets of early sun stream through the trees, melting on my skin, giving me goosebumps. I shiver and jog slowly to warm up, watching the relaxed runners chatting, pinning on race numbers, and the serious runners alone, earbuds intact, stretching on the grass. “Fifteen minutes to race time!” […]

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June 3rd, 2016

The Sound of Silence

Charity Maniates, MSPA, MPH, PA-C

Skilled rehabilitation facilities are faced with a troubling trend. Rather than the majority of patients recovering with straightforward joint replacement surgeries, these facilities have become a crossroad for patients to transition to long-term, palliative, or hospice care. Patients discharging from the hospital assume that during a period of one to two weeks, they will transform […]

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April 27th, 2016

A Shift Towards Well-Being

Charity Maniates, MSPA, MPH, PA-C

It’s 3:00 pm in the nursing home — a pivotal moment each day when residents are jolted out of their daytime routine into the regimen of the evening. For the staff at the facility, it’s simply the daily change of shift. The elders sit in the communal living space, dotted with mismatched chairs, a small table […]

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March 22nd, 2016

The Art of Listening – Beyond Your Patient

Charity Maniates, MSPA, MPH, PA-C

Opening the door slowly, I poked my head in the dimly lit room and glimpsed my patient’s petite frame leaning forward in her bed. I sat on the edge of the mattress, noting how tired the patient looked. The physical therapist was concluding the last session prior to her discharge that afternoon. After inquiring how the […]

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February 18th, 2016

The Human-Centered Alternative

Charity Maniates, MSPA, MPH, PA-C

My 19-month-old son wrapped his legs around my waist and pointed to the fluorescent ceiling light centered over the small hospital bed. I noticed the tiny hospital gown and socks in plastic packaging waiting to be opened. A brightly colored stacking toy sat on the window sill next to the computer and piped-in gas lines. […]

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January 13th, 2016

Off to the Races — Maximizing the PA Role to Fill Healthcare Gaps

Charity Maniates, MSPA, MPH, PA-C

What do you want to be when you grow up? It’s a question we hear from childhood, innocent but underscored with pressure to have a life plan by the age of 18. Realistically, it’s a journey of many experiences, successes and failures that lead individuals to gratifying careers. My first career choice as a 10-year-old […]

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December 2nd, 2015

A Melange of Medications

Charity Maniates, MSPA, MPH, PA-C

It’s unavoidable — treating the frail, confused, 80 year-old patient with congestive heart failure, atrial fibrillation, type 2 diabetes mellitus and chronic kidney disease in your office, emergency department, or hospital ward. In geriatrics, often acute presentations are the result of harmful medical interactions, resulting in falls, toxicity, delirium, or acute kidney injury. Over time, many […]

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October 28th, 2015

Much Ado About a Fall

Charity Maniates, MSPA, MPH, PA-C

Charity Maniates, MSPA, MPH, PA-C practices geriatric medicine in Maine. At 3:00 AM the pager furiously buzzes on my bedside table, jolting me out of sleep. I grapple with my iPhone and call the nursing facility to address the emergency. The nurse brightly reports that a patient had a fall without injury — her third […]

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