As you are going through your Physician Assistant program you get inundated with this huge amount of info. Every minute of every class is jam-packed with information that you will be expected to know when you graduate. Not just so you can pass a certification exam, but so you don’t kill somebody when you finally start working as a full-fledged Physician Assistant. At some point in time when all this knowledge is being packed into that head of yours, you are going to wonder; “Will I remember all this? Will it all stick?” Hell, you might even be so brazen to ask your professors those very same questions. (I did.) I asked my professors, fellow students, preceptors, my wide, the school librarian, my parents, and anybody else I thought might give me some glimmer of hope that all this stuff I was learning was not just flying out as fast as it was being flown in. As it turns out the answer I received from everyone was essentially the same. “Trust yourself, when the time comes the information you need will be there for you.” I swear it felt like I was asking Master Yoda about this. I mean what is this “trust yourself” crap. C’mon people, I turned to you for advice about a very serious concern I have over my ability to consume, digest, process, and then regurgitate enormous amounts of information that will become essential to my ability to keep someone alive and you give me this sh!+ about “Trust yourself, it will be there for you”. What kind of half a$$ answer is that?
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Sorry about being away for so long. Real life has been taking its share of my time, keeping me away from the computer.
I have been dreaming a lot recently about what I would do if I was not a Physician Assistant? Like what would I do if I could do anything I wanted? I thought that being a fireman would be cool, but my groin chafes easily in the heat so this might not be the best idea. Then I thought about being an astronaut flying around the stars and exploring the galaxy, but I get really queasy during long trips so maybe not. Oh, I know. Start working on my acting career. “To be or”… this is not to be. How about spending my days hanging around in a strip club? Yeah, that would be great. Getting free food, having gibbering big busted women running around in tight clothing pushing their breasts all in my face and telling me a bunch of lies about how awesome I am in order for me to feel better about myself. If they manage to stroke my ego just the right way, I will become a bumbling idiot that has lost all common sense and while I am dribbling all over myself these ladies are making some serious bank.
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What do you think?
I had a very interesting encounter with a patient’s mother the other day and wanted to get some feedback from the Physician Assistant community on what you would have done? I am curious, how you would handle this situation?
This 25 year old Asian female presents to the clinic with a chief complaint of vaginal odor and some discharge for the last 3 days. I walk into the room, introduce myself and begin gathering some history from her. She is a sexually active female with multiple partners. She does not “need” to use condoms for protection because she takes birth control pills. She denies any other symptoms other than the “fishy odor” and mild discharge. I hope this is sounding like bacterial vaginosis to you, because it sure did to me. Our clinic is not the fanciest, we don’t have slides available to confirm with KOH or look for clue cells. We generally make this diagnosis clinically. I do like to do a urinalysis, pregnancy test, and STD screening. If the patient does not respond well to treatment, then we will work this up a little further with a vaginal swab. I explained to the patient a plan of treatment that included a few labs and a prescription for Flagyl to treat bacterial vaginosis. She asked me if it was ok to go get her mom from the lobby. Mom apparently is a certified nursing assistant and the daughter likes to run things by her.
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When an Exam is a Family Matter.
So I have had this idea brewing in my head for my next blog, but have been unsure of exactly how to get it started and I decided (finally) to get it started with a story. Well, several stories actually.
(I sh@# you not, these are actual clinic encounters that I had. Even Stephen King could not make crap up this good.)
I have this 22 year old Vietnamese female with a complaint of left ear pain. She is accompanied in the exam room by her two sisters and her mother. After a brief exam it is apparent that she has a cerumen impaction. (Gobs of ear wax stuck in the canal for those who don’t know.) The treatment for this is pretty standard. You get the ear wax out and presto chango, the ear stops hurting and the patient can hear again. In my clinic we use a lavage technique, basically irrigating with water until the plug-o-wax pops out of the ear. So I explained what I wanted to do with the ear, how it will feel and how she should expect to feel afterward. After some quick Vietnamese banter between the five of us (I don’t speak Vietnamese, but I did nod my head yes a lot while they spoke); myself, the patient, the two sisters, and the mother all agreed that this would be the most appropriate next step. I got a medical assistant going on the lavage and continued to see my other patients. After a little while the medical assistant tracked me down and let me know that the ball-o-wax was not coming out completely and the patient is stating that it is starting to hurt. Ok, no big deal. So I go and have a look at the ear. Sure enough a good portion of the lump-o-wax had broken free, but some still remained adhered to the canal wall. I spoke with the patient about this and laid out two options. Option one is to get her to go home and start using Debrox, an ear wax softening agent, and return in one week so we can finish the job. Option two is for us to continue working on the ear in the office. I then asked “Would you like us to continue to work on the ear today?” The answer was an immediate “NO!” The problem was that this 22 year old patient that I was looking at never said a thing. So I asked again “Do you want us to continue to try and flush out the ear?” “NO!” (Again with the ventriloquism.) As it turns out this adult patient was not answering me at all, it was her mama that was fielding all questions. This got me going a little so I informed the mama bear that her cub is not a cub at all, and that I needed my patient (a grown woman) to answer my questions. This got the little Vietnamese lady freakin pissed off to the extreme. I don’t understand Vietnamese, but I sure as hell know when I am being cussed out in any language. I had to spend 20 minutes arguing with mama bear about her daughter being an adult and that adults make their own medical decisions. What a monumental waste of my time.
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You'll be there before you know it.
If you are looking at this you are at least curious or have had the epiphany that this profession is for you. Once you make that decision there are some check marks needed along side a number of tasks that become your list to professional success.
First: no one gets into a PA program without taking the appropriate college courses. All schools want 8 hours of anatomy and physiology. They can be combined over 2 semesters or one semester of each and they must include a lab. UNC in its premed curriculum only provides a one semester combined course that is not accepted by 95% of PA programs. Look at the info in the PA Path.com and on the website of the program to which you are going to apply. Details change from year to year. I had to update the information on Duke and Emory this month due to requirement changes. Know what you need and if specific courses from your college fulfill requirements.
Create a time line on a paper and write down all the courses you will need and when you will have them completed.
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Does anybody have a lemon???
The patient exam
(Oral Practicum)
The misdiagnosis – learning to lead with your heart
There is so much to learn in PA school in a short amount of time. It has been referred to as medical school packed into 2 years – an analogy of drinking out of a fire hose.
Beyond testing the learning of each organ system and the associated disease processes and presentations, we are occasionally tested based on an actual patient encounter. An opportunity for our teachers to improve our bedside manner, communication with patients, and review our diagnosis and thought processes. Our program has a faux medical clinic which appears everything like a real office. From the waiting room to the patient rooms it appears like a typical new medical clinic. Our patient experiences are filmed, reviewed, critiqued, and ultimately made available for us to watch. The patients are paid actors who are given instructions to follow. Charts are on the front door and we aren’t aware of the chief complaint until we get to the door. After the encounter we have a professor (doctor) available to whom we present the case as typically done in the medical field.
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Show me that $$$
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Congratulations, you made it! You completed all the required courses of study to become a full-fledged Physician Assistant. You went on rotations as a student in real clinic settings and were judged by your preceptors as having the skills and knowledge to become a full-fledged Physician Assistant. You passed the six hour NCCPA exam, you were granted a medical license from your state, and given a DEA license number to become a full-fledged Physician Assistant. Now it is time to get out there and work like a full-fledged Physician Assistant. Finally you get a chance to make your own decisions about the care of your patients. No more professors, or preceptors or anybody telling you what to do with your patients. Your first patient of the first day on your first job is in the exam room and ready for you. You review the chart; he is a 55 y/o male with no significant medical history. His blood pressure is 142/86, and he weighs 206 lbs. You make a mental note to talk to him about his weight and elevated blood pressure. You stand up, check to make sure the PA-C name tag is prominently displayed, stethoscope ready, pen is working (lets do this). You walk up to the room, knock on the door, walk in and are ready to bust out with some serious medical knowledge. This guy is so lucky, he is about to get the best medical visit of his life. You start to talk to him and it turns out he is here for his annual physical exam and blood work. He has a family history of heart disease (his father died of heart disease at 75). Otherwise, he has no real complaints, feels fine, and states that his blood pressure always comes up when he comes to the doctor’s office. His physical exam is unremarkable and yes, you did check the prostate.
Here's a novel idea!
It is possible as a Physician Assistant to run and own a medical clinic. The possibilities seem very exciting and as one can imagine the limitless possibilities are intriguing. I am not an expert in this area and I don’t have much time currently to investigate and learn and so I decided to bring this up as a post. Please feel free to leave comments on your experiences or knowledge….
This topic has my attention as I have been approached 3 times by 3 physicians to discuss the possibility in creating a partnership in starting a clinic after graduation. Our class has also received 2 lectures from PA’s who work in a partnership with a Physician and they are business owners in their medical clinic. One of the presenters spent much time on describing how he decided to start his own clinic and the benefits and successes that he has had. Obviously if the clinic is succesful the income potential is very large. There are also the obvious stresses and risks associated with starting a businesses…
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I'm not a doctor but i'll take a look!
If you have landed on this page and are not sure what the hell I am talking about, go to “I’m not a doctor, but I play one on TV.” Part Un. Read that blog then return here and you should be all up to speed. Also, don’t forget to take the “I’m not a doctor, but I play one on TV.” poll after this.
So, this is the second portion of “I’m not a doctor, but I play one on TV.” I never imagined this blog would become so large. I got started on this with one simple word scribbled down in a notepad, “DR”. I wrote it down on a day when I had seen a good number of new patients and had to correct most of them when they said “thanks doctor”. It reminded me of when I was a very green Physician Assistant and it felt like I was correcting people all the time about my title. I started questioning exactly what was I doing? Am I just pretending to be a doctor or am I serving some unique function in the health care system? This phrase “I’m not a doctor, but I play one on TV” kept popping into my head. Literally making me laugh out loud. Of course I have matured in my role as a health care provider and no longer question what I do or who I am as a clinician, but that phrase has been stuck in my head since then. I want those who are looking into becoming a Physician Assistant (I call them wannabes) and those new Physician Assistants (pups) to really understand what they are getting into. Who knows maybe one of them, or one of you have said to yourself “I’m not a doctor, but I play one on TV.”
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Balance is the key to life.
When I applied for school I had 2 pre-reqs in progress (Anatomy and Physiology II And Organic chemistry). I know there is a lot of emphases placed on applying as early as possible.
I submitted my CASPA in April (less than 2 weeks after the application opened) and I finished my two remaining classes in May. However, after my CASPA application was completed and verified it wasn’t mailed to my designated programs until mid June! (This was the first mailing of applications for CASPA, as I contacted them and asked them when they were going to get mailed out).
Before I was accepted to Pacific University I did investigation as to why I was not considered at other schools for an interview.
A.T. Still University in Mesa, AZ was my first rejection letter. When I finished my remaining pre-reqs in May, I had sent the school my official transcripts with the final grades. It was my desire that they would at least see that the courses were completed in order to give me a better chance to get an interview.
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