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…

Justice for All through Health Courts

     

    

A Personal Book Review

  

      

     In his book How Doctors Think the author Jerome Groopman, MD presents an interesting perspective of human nature and clinical practice. He candidly discusses the causes of Medical Errors. In his own experience after much personal and professional reflection throughout his long career, he concludes that besides poor listening skills, detached clinical involvement, and lack of crystal-clear communication among patients and providers, “Diagnosis Momentum” is one of several derailers leading clinicians astray in their medical decision-making process.

 

        He also believed that many clinicians closed the diagnostic process loop prematurely. Thus, failing to begin a new diagnostic process on those patients with “difficult or elusive diagnoses”. This flawed approach or significant diagnostic short-sightedness is compounded because the clinician feels that all venues have been exhausted and there are no other differential diagnoses to consider given the fact that other providers sinched the most common presumptive dx, albeit wrongfully diagnostically speaking. Or our own clinical prejudices take us down the same path that others have ventured erroneously, therefore, failing to prove or uncover a disease state of the patient. 

        He also draws heavily from his colleagues & what he had learned from his colleagues (referrals) also seems to confirm his belief that whenever a misdiagnosis was involved in a negative outcome, it was always due to the rationalization that it was all due to psychosocial issues rather than organic issues. He also felt that many became less humane but more prone to stereotyping their patients.

        Dr. Groopman states clearly his thesis in the book introduction. Here he claims that a lack of inquisitiveness can increase clinical nearsightedness in any clinician.

 

        Fortunately, is not all doom and gloom, since medical error awareness has taken center stage in our industry. Systemic errors are increasingly recognized as many of the underlying factors contributing to medical misadventures.

 

         By understanding cognitively our shortcomings and negative attitudes, then we can begin improving healthcare delivery safety. But more so, by discarding those bad habits and incorporating our newly found knowledge and ethos can improve diagnostic reasoning.

 

So, yet another painful lesson can be learned from our practices. We need to maintain our patient advocacy call and vigilance up at all times and not let our professional guard down. We can no longer afford to be paternalistic nor disengaged or indifferent to the plight of our patients if we are to discard risky clinical outmoded practices. We can do better…we must do better. Without a doubt a great read for any clinician whether you're a novice or a seasoned veteran.

 

 

Strained Interprofessional Relationships: When PAs are ( unfairly) Scapegoated by Disingenuous Employers.

             Let me be direct and possibly blunt: The business world is rife with contempt, unpredictability, and unfairness. And so does the employing marketplace, especially when hearing or reading about uncertain revenue trends, increased regulatory burdens, and/or inconsistent or challenging reimbursement models seen across the Healthcare industry. Naturally many healthcare executive leaders or administrators are quick to point out & “vent about their financial organizational hardships” and how imperative is for every organizational employee to be fiscally responsible if they are to survive the current & continuous economic turmoil faced every day.

            Unfortunately, given these financial stressors & “reality” to most healthcare organizations, frayed relationships are beginning to rise & impact PA’s relationships with their CEOs & other deep-pocketed healthcare executives. Mostly due to deceitful dishonest corporate mandates or strategies used to curtail, eliminate or streamline salary-benefits packages of Advance Practice Providers ( APPs ). These alleged “financial woes” as given & used on many CEO-employee forums ring untrue and are very hard to stomach when there’s a deceitful agenda behind them; particularly if the company is thriving otherwise 

            Many clinicians fear and stand to reason this compensational “imbalance” has increased the divide and added to the frustrating rage an element of distrust especially when these executives make their obscene year-end “bonuses”. And since most APPs are not union members or hired as sub-contractual if hires we tend to be the “sacrificial lambs first”; after all, & often times we don’t have a voice nor representation as other company employees do.

            However, we do not need to see ourselves as the perennial sacrificial lambs as they would like us to. Our professional interdependence is not a parasitic one but rather a symbiotic one, technically that’s what we need to remind ourselves. We must not succumb to believing their “dualistic message” is the final word or amended dictated reality.

We are in the driver’s seat sort of speak; both directly and indirectly we can exert a profound influence on “advertising” and let’s not forget “public relations”—vital core issues for any business enterprise.

            Yet, keeping in mind that the business world is not regular, nor that industry forces are predictable, it’s best if collectively we remain flexible and adaptive in our transactional dealings with administrative executives.

            We must realize that we are worthy professionals. Also, we’re not doomed to be a submissive, subservient class because of protectionist views or activities exercised by other kindred groups in the industry. Our social reality is one of evolutionary progress as seen through the last few decades. Fallacious arguments and empty rhetoric must be scrutinized so we can think more rationally & proactively while not being fooled by half-truths, and misleading corporate metrics when sitting at the negotiating table with deceitful greedy employers. This day and age calls for a new negotiating perspective for all PAs. One of a “healthy mistrust of authority”. One that emphasizes searching for unbiased facts, probabilities, and objectivity to all stakeholders involved when seeking to find common grounds & simplify these discussions. In addition, we must learn to live comfortably with the uncertainties of the business world. The truth is there’s no single guarantee of legitimacy or truth when it comes to the information age, only skewed information lacking indicators of legitimacy. So try not to put all your eggs in one basket when trying to make an informed wise decision, but at the same time don’t victimize yourself by procrastinating due to paralysis analysis… especially when debunking some questionable corporate fabrications.

            Yet, time after time, whether privately employed or hospital employed, many APPs have found when they attempt to establish some form of dialogue to correct this disparity, or at the very least level the playing field then it becomes rather obvious to them we are always to blame even though we’re steadfast big revenue producers. How wrong is this? Don’t they realize that truthfulness goes a long way rather than obfuscation? Quite frankly, I would think this is not the role nor the message any transparent (ethical) healthcare organizations or employers would like to send to their internal/external constituents when portraying themselves as solid patient-centric community partners.

            Am I wrong? (think of Enron,& Wells Fargo corporate sins) – not exactly the pristine corporate behavior per se that they would like us to believe…right?

            You [we] have a choice; our career transactions are not always fated. The days of skepticism, pessimism, & illusionism are behind us. Moreover, we should be redefining this reality with optimism and a deeply rooted sense of PA pride.