I came across this video on YouTube and I thought it was great. Oh how I remember those first day’s and many an awkward elevator. Hemorrhoids and all!
PA Stories
Tributes and Patients
In Suzanne Collins wonderful series we are presented with a grim depiction of a future world.
A world in which people are selected randomly to become participants in a game:
A Hunger Game
One in which 24 people must fight to the death. Set in an exotic arena with the goal of using “augmented natural selection” to crown a lone survivor.
In the book these randomly selected participants become “tributes”. They are reminders of a society that existed 75 years ago when the poor and downtrodden took a stand against “The Capital”. A cautionary tale of those trapped between the hardship of war, starvation and grave inequality.
Thirteen districts represent different levels, divided into casts and only those in the capital have access to a higher standard of living. A standard sustained by the industrial products of the working poor.
The Right to Survive
The most basic human right – the right so survive is trampled upon in an age of great affluence.
It reasons that the matter should be considered the most pressing of our times.
It’s not much of a stretch to argue that anyone who wishes to be considered humane has ample cause to consider what it means to be sick and poor in the era of globalization and scientific advancement.
Yet in the United States, in this most modern, “Christian”, globalized society we have built an arena. A capital composed of a greedy minority, one that seems content to draw names from a hat and watch with apathy as the most vulnerable are sent to their premature deaths.
Those in the capital, separated from the districts are for the most part unaware of the conditions that exist beyond their heavily gated community. Ignorance seems a reasonable explanation, but it should not be forgiven in lieu of a growing acceptance of the Hunger Games.
Building the Arena
Increasingly I am seeing corporations create workarounds to limit healthcare for their employees. Dole Foods for example a well-known fortune 500 company with 2010 revenues of $6.9 billion is “the world’s largest producer and marketer of high-quality fresh fruit and fresh vegetables”. Operating in more than 90 countries employs an average of 36,000 full-time regular employees, and 23,000 full-time seasonal or temporary employees worldwide.
They have recently implemented a monthly renewable healthcare policy for their employees, a policy that requires all employees to work the first day of the month to qualify for coverage for that month. Since the implementation of this policy just two months ago I have watched 6 patients of mine lose their healthcare coverage while on disability for a medical illness. Yes, they lost their medical insurance when they needed it the most, all poor, all without viable alternatives.
And this is just the beginning.
Patients as Tributes
We create tributes as the minority of great affluence tolerates a system that would withdrawal medical coverage while fighting a battle with breast cancer, deny the elderly much needed healthcare at a stage in life when it is needed the most, refuse treatment without an appropriate copay or identification card, charge four months wage for an emergency room visit.
We trample upon the most basic of human rights.
We create tributes in a “healthcare games”.
The fact that the arena exists is testament that as Americans we have “retained a silence closely resembling stupidity”. We speak of democracy, but it is a lazy democracy.
It always starts with small injustices that once accepted creep into society. During times of recession these injustices are easier to tolerate, there is a line of unemployed eager to take the job of every Dole employee, and a corporation who obviously cares very little about their employees.
As I mentioned before the most basic human right – the right so survive is trampled in an age of great affluence.
It is easy for corporate America to turn a blind eye, but it is in my humble opinion that we as healthcare providers should be held to a higher standard.
As medical providers… actually let me rephrase that, as humans we need to see the beauty in everyone.
We should have no place in our heart for judgement.
We do not know a persons background, we cannot pretend to understand what circumstances they have encountered in their lives that brought them to our clinic, our space, this corner of the universe.
So often we are apt to judge.
We interpret a persons actions as black and white. But it is never that easy… NEVER!
When we judge we deny a person what they deserve when they come to see us, a space to be understood, a space to be free of society’s preconceived notions.
As health care providers there is no greater gift we have to offer, than freedom from judgement.
When we choose to free ourselves from this burden we will become better practitioners… And better people.
We will have the ability to truly change people’s lives.
Juliet:
“What’s in a name? That which we call a rose by any other name would smell as sweet.”
There is a big debate out there. What is the best term for our profession? Is it Physician Assistant or Physician Associate? Or is it something different all together?
Physician Assistant
Patients are already confused by what we do. Wouldn’t a name change just confuse them even more?
Part of this patient confusion comes from the term assistant. It assumes (rightfully so) that we are indeed ”assisting” someone; in this case a doctor.
The term itself would lead one to believe that at some point during their office visit they should have time with the actual physician for whom the PA is assisting.
As a family practice Physician Assistant in a rural setting I usually work alongside other PA’s and Nurse Practitioners. Now-a-days rarely is there a doctor to be found on site. And that is OK, there is always someone available by phone if necessary.
In other words I rarely “assist”.
But, this in my opinion is just semantics. I am proud of what I do as a Physician Assistant and the high quality of service I bring to my patients.
When my patients ask me when I am going to become a doctor, I just smile and explain the millions of reasons why I love my job, why I became a PA and why even if given a free “upgrade” to MD I would never even consider it.
Physician Associate
The term associate is not absent of ambiguity.
Just look at one of the definitions assigned by Wikipedia:
Associate, a person who is in league with the Mafia but is not treated as a full member, e.g. a corrupt official.
Not that there isn’t a bit of a “cool” factor that comes with being likened to the mafia.
I think the big complaint about the term “assistant” is that it comes with a feeling of subservience. In a law firm an associate is a low-level lawyer. The problem with this is that PA’s are not low-level doctors they are something entirely different.
Maybe the main problem is the term Physician
A physician is at the highest level of the medical field. And therefore, the term should be reserved for just that.
For a comparison take a look at variations of the term Nurse:
- Nurse
- Nurse Practitioner
- Certified Nurses Assistant
- Licensed Vocational Nurse
- Nurse Midwife
- Nurse Anesthesiologist
These professional deviation from the term “nurse” are far removed from the original intention.
Here are some other common medical professions:
- Emergency Medical Technician
- Medical Assistant
- Respiratory therapist
- Psychiatrist
- Psychologist
- Radiologists
- Scrub Tech
- Surgeon
- Physical Therapist
- Occupational Therapist
- Physician
- Doctor
- Dentist
- Dental Hygienist
- Nutritionist
- Social Worker
- Phlebotomist
- Pathologist
Here you see many different qualifiers such as: “Therapist”, “Worker”, “Tech”, “Technician” and once again “Assistant”.
Outside of the medical field are other types of professions that exist alongside another “main” profession; Paralegal comes to mind.
One could make the case then for the term Para-medical instead of Physician Assistant, but this is just too confusing. Especially giving the closely related term paramedic.
A New Profession:
In all honesty the Physician Assistant of 2012 is a lot different from the PA of 1977.
Part of what has happened is that we are coming to terms with the fact that in order to be a good diagnostician in primary care one does not need to attend medical school and complete a residency.
There is a minimum effective dose for primary care, and that is probably the education of a Physician Assistant.
Of course while working alongside a physician in a surgical role the term assistant is always appropriate.
So maybe what we need then is an entirely new professional designation.
It is not the “Assistant” or “Associate” designation we should be concerned about but the term “Physician”!
Otherwise we will always be playing the same game, creating the same patient confusion and constantly struggling to find our own identity.
But, if you want my personal opinion the term “assistant” and “physician” are forever two star-crossed lovers… In the words of William Shakespeare:
A Rose By Any Other Name Would Smell As Sweet!
I am reading Seth Godin’s free manifesto titled: Stop Stealing Dreams.
In this manifesto he discusses the history of education in American. How it was tailored to create cogs in an industrial machine rather than the much-needed linchpin’s necessary to drive future innovations.
School has become an industrialized system, working on a huge scale, that has significant byproducts, including the destruction of many of attitudes and emotions we’d like to build our culture around.
In order to efficiently jam as much testable data into a generation of kids, we push to make those children compliant, competitive zombies.
At times I fear the education of doctors and PA’s has headed in a similar direction.
While attending conferences or reading through required CME I feel we have become cogs in a pharmaceutical machine.
One trick ponies taught to think pill first, everything else a distant second.
If we want to create great PA’s of the future it starts with giving our current generation of students the tools they need to overcome the cognitive dissonance that resonates in today’s medical field.
The one that sees an obese, diabetic patient with hypertension as the perfect candidate for Metformin and a new script for Lipitor. Rather than a perfect case for the intense lifestyle interventions and hard work necessary to actually IMPROVE LONG TERM health.
I am afraid many in today’s generation have allowed themselves to be limited by fear.
Industrial, scaled-up, measurable structure means that fear must be used to keep the masses in line. There’s no other way to get hundreds or thousands of kids to comply, to process that many bodies, en masse, without simultaneous coordination.
A Physician Assistant Education of the Future:
Now students have access to more than just the medical textbooks and the best advertising big Pharm has to offer.
We can break the cycle of prescriptions and compliance.
With this comes empowerment and better health care for our future patients.
Also, a greater responsibility.
To be advocates for our patients, pioneers of new innovations that offers integrated approaches to health care solutions.
Not passive observers to a health care industry plagued by misinformation, a pharmaceutical focused approach to patient health at a cost to our patients that is truly non-sustainable.
I was in the clinic late last night.
If you looked at my “numbers” you may wonder why.
But nothing bothers me more than converting patients into numbers.
It goes against everything I signed up for when I chose to be a Physician Assistant.
In order to do great work we must generate revenue. This is what keeps our passion and business afloat.
Money and it’s influence on medical decision making will always remain a necessary evil.
Without money there is no clinic. Without money the health care we want to provide for our patients can never be a reality. Without money we cannot afford to serve those that we aim to help, who in fact may or may not have money.
So then the gold standard for which we all strive is being able to generate a healthy revenue stream and still run a compassionate, patient-centered practice.
This is a tough balancing act… One that requires constant vigilance.
It requires vigilance because as a business starts to make money it is increasingly easy to obsess about this money and start to focus on the revenue stream.
It is easy to lose focus on what generated this profit in the first place:
A genuine concern for the consumer and their needs. You know the people who drive your business.
I have found myself falling into this trap at times. And every time I do I see my business suffer. The numbers of course start to rise at first and it is easy to belive that this is happening because of my efforts to focus on more revenue.
But, I think most of the time it is just a carry over from the previous period… You know the time when I was focused on my consumers.
The patients not the numbers!
When I was in college all I could think about was providing healthcare to those in need.
I am not sure where this came from, but it was something inside of me since I was quite young.
I remember the excitement I would have when I had the chance to go to my pediatricians office for a physical or to have my ears checked.
He had these anatomy books in the waiting room that I just loved to read.
Even at the age of five years old the body inspired me, mesmerized me!
I wanted to practice medicine so bad that from that young age I made a commitment to do whatever it would take to get to that point. I also made a commitment to do right by my patients. Not just do it because it was a job but do it because I could make the world a better place.
The Journey – Your Burning Desire
It really began in high school. Like everyone I love to goof off. When I see and treat teenagers today and they tell me “I am just so bored” I try to empathize, but boredom in my opinion is just a lack of imagination, and a lack of belief in yourself… That you have the chops to do what truly excites you.
I understand where they are coming from. Many kids don’t have the emotional and family support that I had growing up. My parents instilled a belief in me that I could do whatever it was that was in my heart. This is the main reason I made it to where I am today.
Many kids will never get this, it is our job to help those kids, help them to attain their true potential.
But I digress…
For me the sciences were inspirational, they were my passion. Math was a hurdle I had to overcome and it was the one thing I wished I could just side-step, but you can’t. And this is life you have to do things you don’t like to do to make it to where you want to be. So I pushed hard, worked hard, and yes I played hard. But in the end I had a burning desire. Something inside of me that was established at a very young age.
Not Listening to What People Tell You
I tell my kids everyday that they need to be better listeners. Especially to their mom and dad.
But when I made it from high school to college I met a guidance counselor who told me that I would never have what it takes to establish a career in medicine.
How she accumulated this “data” and came to this conclusion is beyond me. But it was demoralizing for me. Came sometime around my sophomore year. I remember it like it was yesterday.
It was as if somebody snuffed my burning desire. Crushed my dreams and in a way a part of who I was. It would take a spark to start it again.
Igniting Your Passion
I was working as a student in “Hall Health” at the time as a phelobotomist. Demoralized by what the guidance counselor told me, convinced that I was on a nowhere path, I somehow found it into the office of an Orthopedic Physician Assistant.
It was at this moment, talking with this man learning about the Physician Assistant profession that the spark was re-ignited. And from that moment onward I knew what I wanted to become.
Redirecting your Passion
I was pre-med. I spoke to a different guidance counselor who steered me into Zoology…. Yes Zoology. It was not a major as many people belive focused around “animals” or working in a zoo but it is a major focussed around nature, life, physiology and the essence of all the sciences. For me the spark turned into a fire. I found a love again in what I was doing.
Upon graduation I was now on the deans list, I had made connections in the campus clinic that led to a job as a mobile phlebotomist for Seattle’s Blood Center. From here I established grounding in my work, moved up the ranks to a mobile supervisor, made more connections, took night classes to get my EMS certification and began applying for PA School.
Reaching your Goals:
From acceptance to practice was a long road. Heck from high school to practice is a long road. You will reach many obstacles along the way. If you didn’t you would never learn to be grateful for what you have, these struggles make you appreciate what you have, to value it and later to do good with it.
Every day that I get to wake up and help a patient reach their health potential is a day I am thankful for.
Every day that I get to throw on my stethoscope and do what I dreamed of as a child is a reminder that in life anything is possible.
But you must work hard, never give up (you know all the normal platitudes) but most of all start believing in yourself… Enough to do what you know you NEED to do to reach your goals. Otherwise you will quit when the going gets tough and make the mistake of settling for less.
I remember my first day on the job like it was yesterday.
I was petrified. When I ask other PA’s about their first day they often proclaim having had a certain sense of calm. For me, it was pure fear.
Possibly it was due to my situation at the time. I was working pretty much solo, in a walk in clinic, in the middle of a rural community with patients who spoke mostly Spanish. I spoke little to none.
The fear had compounded in my my mind based on a variety of predicted scenarios. These of course were bad scenarios that often ended in my patient either dying or coming close to it. I had conceived of millions of different scenarios in my head mostly based on my college obsession with the TV show ER.
I didn’t have enough pediatric experience, my orthopedic skills were shoddy, I had never actually written my own prescription. For the first time in my life I was going to have to stand by my own diagnostic skills.
Doctors don’t have to overcome this fear in the same way PA’s do. They have a residency to ease into it. As PA’s it is just one day you are a student then the next day you’re a prescribing midlevel practitioner.
Honestly, as I write this looking back at 7 years of experience no wonder I was scared senseless.
There is an understandable and probably protective fear that every medical provider should have. That is the fear of doing harm to someone. But there is another fear and that is less protective, it is the fear of looking like a beginner, having to ask for help, letting your patients down.
For me this was difficult. I like feeling in control. I hate doubt. I pride myself on my expertise. But there I stood, vulnerable and scared down to my bones.
I arrived at the clinic early this day of course, which only added fuel to my anxiety. I cleaned my workspace (which of course already was clean because I didn’t have any patients or charting yet) and I sat there in my chair. Living my dream that I had prepared for for so many years. Why did I want to run out of there home to my mom?
I cleaned my stethoscope, made small talk with my medical assistant, I re-cleaned my stethoscope and sat nervously awaiting the clinic doors to open.
And as the front doors of the clinic did finally open there I stood, exposed, nervous for my patients mostly.
In fear that people would discover that I really had no clue what I was doing.
Sometimes what your patient really needs is your time and attention.
This of course is not just true in your medical practice but applies to your life in general.
We get so caught up with things that can be measured, we look to our prescriptions pads for the answer.
But I will tell you this: What people really need is to feel listened to, and to know that you value their opinion.
We are often in such a hurry to get to the next patient. I understand this is usually not your fault. But if you take the time to give the patient what they truly need, you will have an office full of patients.
Patients that are healthier and better off because you gave them what they really needed.
Not just another prescription.
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