A Profile of the Lawsuit-Prone PA: Could you be one of them?

 

       Throughout our clinical year in PA school, we heard over and over the importance of obtaining a good history and documenting an accurate physical exam. Yet, there have been many times we forego obtaining a detailed history and performing a thorough physical exam because we think we can “cut a few corners” once we have become “seasoned” or “experienced “or even by simply relying on—possibly unnecessary—diagnostic testing.

         Tragically, this “false sense of security in technology”, and disregard for clinical thoroughness has led many PAs down the wrong path. Particularly, when the patient suffered an adverse outcome. Much to their career’s detriment, some PAs never realized that they incurred in significant self-liability risk exposures when adopting these detrimental clinical style practices or attitudinal views.

         Unfortunately to their chagrin in these instances, they found themselves embroiled in lawsuits alleging two common types of negligent claims committed: either by “omission” or “commission”, stemming from their poor history-taking style. All this stems from the fact that many do not know how to elicit a good, detailed history from the patient or simply due to clinical laziness. In other instances, due to insufficient time. Often is not so much what was not queried, but how was it asked? In other words, not probing for historic temporal specificities regarding onset, duration, frequency, location, etc. of the ailment/illness. In essence, the root of this clinical complacency habit can be seen most commonly when asking closed-ended questions as opposed to using open-ended questions.

          Case in point, a chief complaint of chest pain can have multiple etiologies as the underlying cause. Non-rephrasing or not re-querying a patient until a detailed history and thorough physical exam have been performed can lead the PA easily astray in his/her decision-making process. Thus, at best potentially robs the patient of an optimum outcome or an aggressive strategy if called for & at worse places the PA provider @ legal risk. Particularly when dealing with some life-threatening situations, thus muddying the clinical picture or presentation at hand.

Plus, another significant derailing factor is the lack of considering & documenting the clinical decision-making process along with listing respective Differential diagnoses along with the potential probabilities and what diagnostics were undertaken or other data refuted the likelihood of them in the workup.

Physician Assistants: Unsung Presidential-like Healthcare Professionals

            

        When it comes to naming the toughest job on the planet many are quick to point out that being President of The United States is at the top of the list. It’s not difficult to see why and understand this at first glance, but at a closer look, the same could be said about a few other professions too. However, I would submit to you that we [PAs] are about as close as any other ones. How might you say? Literally or metaphorically speaking, we [ PAs] are akin to the president in many respects, to a certain degree & in a general sense the same intense collective challenges, scrutiny & tremendous unrealistic expectations by so many others.

        Much like the president nowadays, facing daily increased pressure with compounding transactional complexities, requiring intense flawless decision-making moves, so do us practicing medicine in a fragmented, chaotic industry notorious for its very unforgiving litigious atmosphere and the ever-increasing world of burdensome regulations.

       Similarly, we’re expected to be assertive, but not domineering in our dealings with others, deliberative, but not appear indecisive all while advocating and empathizing without overpromising when being called to be stewards of the imperfect healthcare system (i.e., money-hungry Big Pharma, profit-making 3^rd party payers, an inefficient tort system and the list goes on).

       Also, historians and political observers agree there has been an increased disdain for the oval office in recent years. For instance, the press media was once considered less sensationalistic in their coverage of our presidents’ limitations like FDR’s wheelchair-bound existence or JKF’s notorious extra-marital affairs. Naturally, we the PA community are all too familiar with this surge of intense inter-professional disrespect in recent years, and the cyclical cyberspace backlash is also part of this malady. The never-ending misguided and misinformed portrayal of the PA community or being devalued in the broadcasting and print media has not gone unnoticed by our community, nor is it new nor will break our spirit. Just like past presidents, who must be balanced true diligent advocates, perpetually being strategic visionaries, in that stance, we similarly embody the positive traits of all our great presidents even though our job may be viewed as nonpresidential. Yet, while we might not sit in the oval office,  our jobs are often times the second or the 3^rd “toughest job in the world”,,,akin to the president's in my view.        

Keeping the Faith despite the stories they tell

      As the year comes to a close & after 34-plus years as a practicing PA and medical educator, I've never seen the level of inter-professional and intrap-rofessional intolerance seen nowadays in the healthcare industry. It has become practically Toxicity on steroids. All boils down to constant daily undermining transactional attacks of one form or another, whether very subtle to openly overtly. I see this daily in how some people and professional groups have made their personal and professional intolerant ideologies an urgent mission to be instilled and implemented @ any cost.

     The PA community, unlike any other group, has taken the brunt of this divisive assault that has become deeply ingrained in the medical profession, and more importantly, the ever-deepening damage it’s doing to all providers and patients alike throughout the western world and our country.

      From the moment the AMA went public minimizing and discrediting our profession, our industry contributions, etc. the opposition has been relentless & fierce. Among the numerous insults and accusations that have been hurled our way by those frightened by our success have been some of the  following:

● We’ve been called “Physicians wanna-be”.

● We’ve been called unsafe providers.

● We’ve been called unqualified deceptive healthcare providers.

     Just to name a few here. The one thing we haven’t been called yet? Probably has been visionary...That is thanks to the tireless work of thousands of our brothers and sisters seeking daily improved quality access to health care along with very few brave supporting physicians who seek to accept our brand & integrate us harmoniously into the very fabric of a fractured flawed industry.

      Fundamentally, I’m proud of them and those who see our adjudicative value.  I’m proud of our community for how hard we fight together for what we believe in despite all the industry naysayers.

       Shouldn't “Do No Harm” be the mantra by which we all measure our individual and collective actions by believing in giving everyone equal access to health care, in upholding the highest standards of medical ethics, and in unleashing a new era of life-saving medical breakthroughs? Shouldn't we also believe in allowing all professional medical providers to practice under the law to the highest scope of their practices thus helping everyone lead a healthier and happier life, regardless of who they are ( DPM, PA, NP, CRNA, OD, etc.)?

        Upon further reflection, I am hoping that we can overcome the forces that threaten the health and well-being of every American. We have a long way to go, and the forces arrayed against us are powerful. Yet, most of our fellow Americans and my fellow medical professionals/comrades realize this. We undoubtedly want a fair leveling playing field in which medical services are provided efficiently and transparently--nothing more nothing less. Is that simple.

        If we could only stop this bickering, finger-pointing we could elevate an industry beyond our imagination for 2023 and the years to come. Thank you for your professional tenacity, pride & hopeful outlook during these turbulent times. Keep the faith...despite the stories they like to tell.

My Pre-PA Journey

      There are many essays and blogs about folks relating to knowing about their early calling in life. For instance, such as: “I have always known that I would be "A" or "B", etc. You know the drill. Well sorry to say or disappoint, but this piece is not one of those stories you see quite often.

     Nor will I use the clichéd stories of how an ill relative or a friend or a close family physician served to be the inspiring force for me when considering a career. In fact, unlike so many other college students’ paths to medicine, mine was truly a circuitous one compared to so many others that I have known or read about. 

       Truthfully, I was never ‘pushed’ nor ‘talked’ into going into medicine by my parents or anyone else either for that matter. However, medicine didn’t cross my mind until I began enjoying my natural science courses as a freshman and sophomore, and junior in college. I felt I would end up pursuing a graduate degree in molecular biology. I even thought about being a bench researcher in the lab after graduating from college or becoming a medical technologist. 

        Basically during this time, I was setting my sights on landing a co-op job experience as a research student @ Argonne National Laboratory--- far from becoming a PA  back then. 

        Halfway into my 3^rd year, I began to feel an affinity for medicine as a potential occupational possibility, so to explore that late interest in a medical career and not with the romantic idea of becoming a doctor I decided to explore employment opportunities in a medical or a hospital setting. In a stroke of luck, I was able to land a job as a Pharmacist Assistant while completing my undergraduate studies. 

        Luckily this particular experience gave me a different perspective, a very insightful one on my desired career path. As I neared graduation, my options became clearer, and my desire to remain in medicine albeit in a different role was cemented; it was clear that my future would require a more definitive game plan from my behalf. For years, I methodically researched in depth about the different allied health careers, from “A” to “Z” and while the infinite options were considered and entertained, no would-be profession back then matched or resonated closely as much as the Physician Assistant Profession did for me.

             And the rest is history as the saying goes…    

                                                                                                                                           

One PA's dream

          

        PAs are a very diverse group, if not an eclectic one. Yet, having been one myself for the past 34 years, I know and feel like I am no different from my peers. We all have and share some same professional needs and career desires, Nevertheless, I believe and feel this dream of mine is pretty universal...I suppose. So. let me depict that dream for you, if I may.

        I get up every morning and stick my head under a hot shower head after shaving the night before. I get my lunch bag ready and I shuffle off to work while listening to the radio on my commute. Once in the hospital, I checked the surgical board seeking for added “emergent” cases that were added in between the elective cases. scheduled for that day  Shortly after, I meet with the ortho team (residents) and we go over the service patients list and divide the workload accordingly before reconvening at the end of the day one more time.

       However, as much as I try to keep my mind on my work, I can not help myself having fleeting visions of my dream in my head throughout the day. In that dream, every PA is respected, but moreover recognized & treated professionally by all other team members including the hospital administrators, the department heads or managers, etc. In that dream, PAs are not viewed as second-tier providers when compared to other Advanced Practice Clinicians or even by some misinformed recruiters or better yet: misinformed patients

       In that dream, we are recognized with legislative equity and parity, without regulatory barriers or reimbursement constraints. In that dream, not only do we continue validating our established reputable industry legacy, but we surpass it by taking ourselves to new heights of professional respect and universal recognition even in the eyes of the detractors.

        While no one has the luxury of daydreaming @ work all day long, nor do we think we may have a choice in the matter of improving our group destiny, the truth is, we can if we convincingly unite as a single voice and educate and speak out against those who seek to divide us or deprive us of our remarkable great professional advancement over the past half-century.

         Hopefully, in the near future, it will no longer be a dream but an affirmed daily reality!

The AMA: A Policing Organization?

       Every time I hear or read about the AMA meddling in our affairs, I must confess: I get more and more worried about our future. Their constant open disdain of our profession so openly seen on various platforms not only troubles me but should also the rest of us. However, and quite frankly, I am surprised to see just a few in our community denounce them. Even if nothing else, I’m sure most PAs have felt the sting of these disinformed one-sided campaigns targeting our brand.

       But just as if this is not enough, the current marketplace is changing at a rapid pace potentially where the perception and the stigma of being an "assistant" have never been more detrimental to our livelihoods.  For instance, the AMA behind the scene attempts to block or lobby against any PA modernization practice acts. By far the most disturbing and disheartening politics of their rhetoric is how to attempt to sow fear and distrust in the medical consumer. Clearly, they seek to undermine our credibility at every turn they can by deliberately overstepping their industry role by simply fostering PA practice advancement barriers.

       Similarly, and nefariously they have undertaken other lobbying efforts to jeopardize similar PA practice modernization bills throughout the country all under the mantra of "patient safety". When asked directly about these interprofessional restricting marketplace activities, they always default to their skewed anecdotal statistics. They steadfastly continue claiming their actions were/are solely based in the interest of public safety despite the robust available data today, fifty years later proving our solid industry track record regarding comparable patient care outcomes--- a very solid one indeed.

       Unfortunately, they have chosen to discredit the PA community through these unilateral overzealous partisan protectionistic lobbying moves without creating a spirit of collaboration or bipartisan dialogue. I/we do not believe this to be the trait of a transparent organization as they like to claim. Furthermore, I/we believe these lobbying activities are not appropriate nor in the best interest of creating a professional partnership between both groups. 

       It does appear, the role and mission of the AMA are incongruent if this is the stance they want to undertake. Furthermore, they are not a “regulatory governmental agency “ nor a “policing” agency but rather an association of an interprofessional group.

      Perhaps, they should be reminded they are not in the business of trade restraint & or fomenting interprofessional dissension, but rather collaboratively increasing access to care. 

Would you all please make your voices heard…