PAstroika: Metric or just a trendy Buzz word?

In recent years we have seen trendy terms & concepts come and go. However, when “transparency” became entrenched in our day-to-day vocabulary, our day-to-day expectations and/or dealings with all businesses, it kind of felt different. It truly began feeling right, not to mention it felt hopeful when it came to any type of transactional accountability expectations between two parties.

Used in a transactional and transformative business new paradigm context, it seemed like we were moving in the right direction—one leveling the playing field. For a moment, it seemed transparency represented a new higher standard of corporate behavior sought, expected or even aspired by all parties involved—external and internal customers included. Particularly when seeking to build mature & respectful relationships among both stakeholders.

But in recent years, we the PA community have disappointingly witnessed 1st hand how difficult this process has been for some companies to engage in it, and adhere through their public promise to embrace transparency and reform. 

The offending TV Networks

Unfortunately, I can not think of a more hypocritical & unprofessional  example of this issue than the unflattering portrayal of the PA profession through the TV major Networks. For instance, one of the most recent derogatory media references was when our profession, was  ridiculed in a satiric comedy show titled “Night life” aired on Feb 23rd, 2015. Essentially in this particular episode our education & training was utterly mischaracterized and trivialized as nothing more than “scut monkeys” pushing paperwork while trying to become physicians. 

As if that wasn’t enough, on March 4th,2014 the PA profession was again disparaged on prime time TV on the O’Reilly Factor broadcast. 

Similarly, he [ O’Reilly ] basically grossly misrepresented our rigorous PA training and the quality of our care-giving services by stating that we were akin to “Lenny”— a fictional community college graduate metaphor he used to compare our background against physicians. Contextually through his commentaries that night he implied the American healthcare consumer receives subpar care when care-giving services are provided by the Physician Assistants’ community.  

To this author and the PA community this Fox News report was extremely offensive, denigrating if not to mention unfair and unbalanced. It makes one wonder what ever happened to fact checking when reporting not only on a professional group, but anything else too. Almost a la “Rolling Stone” magazine "Faux pas" before the days of cancel culture. 

Along the same vein, even ousted Nancy Snydeman, MD former NBC New’s Chief Medical Editor misspoke about our background/role and our limited prescriptive abilities when caring for patients in a segment aired March 11th 2011.  In her defense and unlike the other TV show producers, she later, tried to correct her statements on her Facebook page the next day. Somehow, it felt insincere.

        So how did they slipped into these non-transparent behaviors? 

Essentially, at the core of their mischaracterized broadcasted reports was the fact they did not bother to research nor present factually the issues. Instead, would have they sought a more balanced reporting, these probably would have shown/depicted a very  more balanced group of highly schooled and skilled healthcare professionals: namely Physician Assistants community

        Unfortunately, journalistic integrity is dead & all three networks choose to forego their journalistic responsibility and the end result was the grossly and inaccurately misrepresentation of a highly validated & well-respected, cost-effective care-givers professionals to the healthcare consumer. 

Sadly, these examples illustrate the inherent egregious blunders each TV network committed and failed to apologize for their offensive and insulting aired transgressions. Generally speaking, these dismissive organizations not only lost value in the eyes of the PA community, but credibility as well tto this author. Clearly, not correcting the error will resonate negatively in our minds when it comes to TV network transparency. Thus, allowing their overt corporate arrogance to alienate us. 

Isn’t “transparency” bi-directional? 

If we as clinicians, are urged and expected to talk openly about our mistakes, foibles, and disclose harm done to patients and apologize promptly and sincerely, shouldn’t we expect the same from the business/TV industry? I /we would think so.

Therefore, doesn’t the PA profession deserve the same degree of respect, transparency in return?

         So far, it does appear that being transparent to the healthcare consumer is not nearly as important as garnishing high TV ratings, even if it’s disparaging a venerable profession. Frankly, these examples illustrate the inherent egregious distasteful blunders each network committed while failing to apologize for their offensive and insulting transactional transgressions.

These transparency Faux Pas certainly open the doors to speculation and debate on some companies understanding of this expected new transactional behavioral accountability. In short, transparent relationships do matter if you expect to have a trusted engaged readership, and/or viewership in these cases.  

In the world of the competitive diminishing market share & good customer relationship management, one thing is (and should be) key--transparency must be at the top of the list; anything less than that would be a problematic agenda for a TV producer and/or reporter…don’t you think?

Ten Verbal Blunders: Credibility liability in our practices.

Through the years I have seen some of the best clinicians instantly loose all credibility when letting a verbal blunder slip into the verbal interaction @ hand. At a glance what appears to be an honest assertion or an insignificant remark to us, it might not be so to a patient.  Moreover, these tongue slip-ups can rob you of your credibility if not great trusting rapport that you have enjoyed for years.

The following statements or phrases are those culprits alluded too:

1. “It’s not a big deal”: While the single closure of a wound might have not been your very best that day after countless other ones through the years, for the patient  this statement  would be received as you didn’t take the time or cared for the cosmetic outcome. Your careless statement basically discounted their trust.

2. “It’s a slam dunk”:  Sure, easy for you to say since you’re not the recipient  of an unfamiliar procedure or intervention for an anxious or distrusting individual of the medical industry. Patients like to be informed of all attendant risks…not some or partially. 

3.”You’re making this more difficult than it really is”: Your empathy just went out the window with that negative reassuring comment –if you thought it was one. Best practice would be to say, “I will do my very best to minimize any pain or discomfort or possible complications”. ‘I/we will get you through this together”.

4.“Bee sting” : The sight of a needle is anxiety provoking even in the “toughest folks” or “weekend warriors”. Downplaying the discomfort even with the best of techniques doesn’t help anyone under these circumstances. Pain or discomfort should never be “embellished”—just be truthful from the outset. Is best if you tell them you will be as gentle as you can be. Again, never say  ”this won’t hurt you”.

5.”There’s nothing wrong with...” This dismissive statement simply translates into the patient’s mind that you doubt his/her concern or complaint being legitimate. 

Before closing the door diagnostically speaking it might behoove you to do some preliminary testing or investigation. Avoid early diagnostic closure, ( aka Anchoring—a medical heuristic ) especially if there’s a unexpected or bad medical outcome.

6.”Guaranteed, this will...” get better and/or resolve in 2 days…2 weeks… 2 months. Assurances are best to leave out of discussions, rephrase outcomes or your expectations in terms of probabilities instead. For instance:..”my best guess is…” by using this statement,  the patient will be less disappointed if the course of the illness or ailment takes longer to resolve or improve.. Early resolution, and you are a hero—simple as that.

7.”Sorry for the delay, we’re busy today.”  Patient’s view their time just as important as yours. If there’s a delay notify them @ once and explain that you will be late. They will be appreciative if you can re-schedule or give an approximate time of seeing them. Saying you’re busy is not as good as saying an impromptu situation caused the delay thus requiring your immediate attention before seeing the patient. Always close or state you appreciate their patience & understanding.

8.”Oopsie”: Not something you want to say when a mishap or an error happens. This word does not mitigate the bad outcome or the unintended consequence even though you might think so. Be honest and use a direct approach when explaining what went wrong or possibly caused the departure. Stick to honesty.

9. “I’m the best @ this”:  Based on whose opinion—Consumer’s report? They think not. Perhaps stating how many X-Y-Z procedures you have done with safe outcomes might be more prudent and less arrogant-sounding to their ears. Moreover, it would be best if your supervising attending physician or colleague would endorse you by saying or praising your accolades even though there’s nothing wrong feeling you’re the right person for the job or task at hand.

10. “I have nothing ‘ else’ for you…I wished“: Short of a terminal illness which you can always consider palliative or hospice care, you must consider exhausting all medical resources and/or venues before uttering this “I/we’re give up” on you. We must keep a balanced perspective (naturally) and accept that we are not to engaged in practicing futile medicine, but we must not abandon ship to soon if there’s some significant statistical chance of medical recovery. 

Sometimes another medical perspective is reasonable and needed. Remember, each and one of these statements, words or phrases could easily undermine your patient’s trust. Place yourself in your patient’s shoes if your to be the recipient of these verbal faux pas. You would feel resentful or upset at the very least. Don’t you think?   

So, before you engage your tongue …you must engage your brain to avoid these verbal blunders be part of your day-to-day communication. 

An Open letter to all PAs

    If you are a proud  and professionally engaged PA, chances are you would be intolerant and very critical of the recurring mischaracterizing narrative about our profession. This growing anti-PA narrative seeks to sow doubt in the patients’ minds mostly by disparaging our highly studied/documented  great patient care outcomes across the board through the past 54 years.

    Stopping this malignant spread of interprofessional bigotry does require the commitment of many if not the entire PA community.  We must not only be alarmed, but morally concerned --if not outraged-- about the long term negative ramifications this may pose to our standing in the healthcare industry. Truth be told, I personally and professionally after 34 years of practice never been more alarmed and concerned about this than I am seeing take place in the marketplace & various media outlets these days.

    Our work history, our Industry credibility speaks for itself, especially when it comes to delivering the highest competent patient care as it has been shown study after study. 

    But most importantly, and pressing is the fact that we don't have a moment to lose. And if you think about it, we are at a crucial crossroad determining the battle for our survivability. Make no mistake, about this: our fate is in our hands--not in the AAPA’s. Moreover, we still remain “brandless” to most Americans. It is very clear, we still are viewed as a subservient professional class to the various stakeholders & physician communities. Even the mainstream media has failed to be objective when it comes to describing the physician assistant community contributions to the healthcare industry.

    And quite honestly it is up to each and one of us to get active and vocal by joining together and educating, and advocating for our very own cause. I do believe that we should entertain the idea of creating a PA Watchdog organization  in order to secure our own vested interests given the current anti-PA climate. Naturally, coming together in seeing this shared vision come to fruition will help police those seeking to erect barriers or foster industry inequities by eliminating all prejudicial interprofessional ignorance.

    Just remember, become an educational activist in your profession. Do not allow your peers or yourself to be silenced or marginalized for that matter. It is simple to see, we need everyone to come together and have our voices heard.  After all, “PAs” matter too!

Patient Safety Outcome Metrics Disputed: Where is the outrage of the Physician Assistant Community?

     

        The problem with half-truths, or media disinformation is that oftentimes they are actually believed if continually repeated or perpetuated. Unfortunately these incorrect spins can become deeply ingrained in the collective mind of people; especially when grossly out of context or worse yet, not corrected contemporaneously by the reporting entities. Sadly, and  painfully, a very well known reality to all PAs who have experienced this stigmatization first-hand in their respective careers by the misinformed patient, practice manager or even dept. head administrators. Even more troubling to this author is the apathetic indifference of many of our own peers who remain complicit with our detractors or opponents in this regard.

        Primarily the objective data ( patient safety outcome care metrics) reflect very similar clinical care outcomes between our physician counterparts and us-- the non-physician providers as some like to refer to us when compared by others.

As I am sure, you have noticed our profession has been maligned for several years now. Whether it is overtly or not, we have yet to surmount a credible vigorous rebuttal campaign with political muscle in Washington, D.C. PAs for Tomorrow, a recently created Specialty interest group, splintered from the AAPA given their indifference or anemic stance when creating and developing the PA brand. While they may have been proactive in educating many in advancing our interests, at the end of the day they are somewhat limited since they rely mostly on donations and membership dues. Sadly, to this day, The AAPA has not advanced our brand aggressively nor launched a major national advertising campaign aimed @ focusing on our most pressing initiatives in the marketplace today. For example, nationwide OTP acceptance @ once...not 10 years from today, loss of employment parity due to the strong alignment of the AANP (nursing profession) with  strong lobbying supporters. These organizations openly support & fund generously the nursing profession, thus creating friendly Congressional lobbying allies. Unlike our community which we lag behind because we have not learned “the Art of the Deal” by being timid in advocating our own cause, so we remain marginalized...so where's the outrage from the PA community? Obviously, yet to be heard.

But, if we continue being passive, uninvolved in our own affairs, the outcome of our professional destiny then will be fated. 

I hope that this incorrect patient safety narrative spewed by some physician groups through various informational outlets would be the catalyst in becoming the driving force to fundamentally change & awaken us from our collective passivity. 

It is my hope that we can all see that without this outrage, we cannot protect and preserve our significant professional advancement that our predecessors secured in our progressive professional evolution.

Stand up and oppose  professional misinformation or disinformation or even more mischaracterization of a great profession that has served you & all of us well. Please, donate, speak and or write to debunk this flagrant lie. You must assert the truth when clarifying or inform others about our magnificent profession.

The Opioid Crisis: Who is really to Blame?

        Finger-pointing for this debacle and health crisis has been widespread, albeit skewed and unjustly zeroed on the medical community. In my opinion, much of it is unfair since I have yet to come across any reading that has taken a more objective in-depth look at the causative factor and asked unbiasedly why it happened in the first place. In other words, place the problem in its proper context by examining the genesis of this debated conundrum and ask ourselves– who is really to blame?.

        Critics have mostly blamed Big Pharma for their greed and the federal government & states for their poorly slow response to this devastating societal tragedy. But one would be remiss if the blame would go non apportioned accordingly, meaning forgetting to recognize or at the very least attribute other entities directly or indirectly responsible for this public health nightmare; to basically go one step further, right?.

So who else should be held responsible? Well, for starters how about JCAHO? The Joint Commission Accreditation Hospital Organization, the quasi-governmental bureaucratic agency that led the well intended campaign named “Pain the 6th vital sign”  back in the late nineties. Based on their researched studies, they spearheaded this idea/project & placed the healthcare industry in a very untenable position since the medical community had failed to address the undertreatment of pain for decades, thus pressuring medical providers to correct this deficiency in the management of chronic pain. Obviously this industrial guilt trip became deeply rooted leading to over prescribing.

By their views, we were told to step-it-up and so we did, because they told us so. Sadly and mistakenly, we failed to pause and reflect on the foreseeable consequences of this moral dilemma. Yes, we must and have accepted to shoulder this imperative responsibility in our clinical practices/careers. Unfortunately, this self-created malady is a classical example of “The Law of Unintended Consequences” – an undeniably painful reality to this day. 

The medical community has strived and will continue to do so when it comes to addressing & dealing with this complex clinical phenomena by becoming more educated & becoming more prudent prescribers. A work in progress to this day, but improving.

           As all stakeholders have become aware of this difficult problem, we should avoid this past pressurized demand. Furthermore, avoid singling out a particular group & stop pointing vilifying fingers. But more importantly, recognize & accept the fact we all played the “over prescribing role” in this disgraceful national opioid epidemic. Simply, we must do it.

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