The Robotic (Automated) Provider

            I think and feel I have a lot to say about how medicine is practiced in this fast-paced business of ours. I've seen it in my own career and in many other colleagues' careers too. In this commentary, I'm going to do something I've never done before or at least didn’t think about it on a deeper level. I'm going to dig deeper into an area of troubling practices, and, I'm going to show you where we have erred and continue to do so in our daily practices. More specifically, what we have become as modern-day clinicians. 

Moreover, why what we or you're doing isn't working as well as you'd like, and what to do instead? I'll show you one root cause of why and where we have abdicated our thinking selves. As medicine pushes for profits, we have been pushed to become “fast thinkers” when providing medical services to the patient community. In many respects, we have become too automated, even in my opinion too protocolized in many instances. Do not misunderstand me, I am not against abiding by following practice or clinical guidelines, or even abiding by organizational protocols. Obviously, they have a role in standardizing medical care. However, be that as it may be we have relinquished our clinical thinking to a robotic mode, or simply the activity of “checking boxes” in our minds.

Cognitive Psychology proves this very clearly. In their lingo, this is known as providers practicing Medical Heuristics (aka rules of thumb). Unfortunately, this unconscious mindset although very convenient for quick decision-making, oftentimes leads us astray in our medical final decision-making activities. Tragically, leading us to medically misdiagnose, or delay the appropriate treatment, as a result the plethora of potential medical errors and adverse outcomes we see occurring across the continuum of medical care. See, this is where we are all doing it all WRONG! Not slowing down to pause & think and look beyond the immediacy or even look at the big picture when making clinical decisions in our daily busy practices. In essence and sadly that has become our Achilles heel.

These battling internal and external forces for better or worse ultimately drive our decisions. As they say, we win some we lose some. But, I would argue to anyone to take the higher road: pause and reflect consciously upon the decision(s) you are about to embark on...solicit more information or much-needed data before proceeding. How do I know? Simple, I know this firsthand & better than most others because I have seen it from a medical-legal consultant perspective time after time. Primarily when I have served as an expert reviewer in alleged PA med-mal claims allegations. And there it is. In plain English & the spirit of sharing, I just had to remind you (my peers) of this ugly reality. One that lurks unnoticed in our daily practices.

            And from a Risk Management perspective, proactively mitigating your risks is what should be your bottom line. Simply by knowing and understanding how and when to implement these tips would definitively mitigate your potential legal entanglements. You must understand how to consciously sidestep them in your everyday patient encounters, whether it is in the office, ED or urgent care settings, or hospital. At the very least, it's another tool worth taking notice of in seeing for yourself what I'm talking about when you put these techniques into practice. It will give you a better understanding of the legal landmines lurking in the background, not to mention a broader view of your risk exposures. 

Start practicing safely and confidently...don’t take chances by being or becoming an automated provider. Better yet, don't sabotage your own career. Stay present, become an engaged provider, and allow your fast (unconscious) and slow thinking (conscious) to coexist harmoniously when making your final clinical decisions. Your patients will be less inclined to raise any potential medical malpractice claims knowing that you balanced your options before making a rash decision. You owe it to them...you owe it to yourself.

Fatal distraction: Compensation talk---keeping your guard up.

 

            There’s one distraction whether experienced or inexperienced every PA job hunter wrestles with during their job interviews--compensation. Especially, if the amount offered surpasses their anticipated expectation for that job.  For many, metaphorically speaking is as if they were cruising at moderate speed and momentarily taking their eyes off the road just to be jolted by the impact of going off the road and landing in a ditch. Conversely, a “generous” compensation offer (i.e. salary) can have a very similar effect. Therefore, this unexpected derailment can sneak into your mind potentially obfuscating the big final picture during or after the interview.

            During that vulnerable period of the interview process, you must be at your best if not your strongest and/or sharpest. Why? Because it’s very easy to briefly disengage and put yourself at risk of becoming distracted, thus easily forgetting to recall all other important key factors that would weigh in helping you make that final informed decision comfortably.

            Conversely, do not allow yourself to be pressured by the interviewer; resist the urge of accepting the job right on the spot. This could have been a gambit used against you. Some interviewers like to play this card-- a momentary tactic to disarm you and avoid those well-thought-out questions you prepared before the interview.

            So, the best protection against this kind of fatal distraction is to avoid capitulating to blind impulsivity. You must respond with a very thoughtful constrained remark such as: “As enticing, & generous your offer is, I still would like to have 2-3 days to discuss this with”… your significant other and/or family, or your attorney.

             But more importantly, by keeping your guard up and remaining grounded when it counted the most, then the less cheated you would feel if the job didn’t work out for you in the end.   

            In conclusion, never accept or negotiate an employment offer on the spot. No matter how good it sounds to your ears or if it appears on paper. It is best to take time and sort things out after you've taken time to thoroughly consider the pros and cons. Remember, right there and then thank the employer and restate your desire to work for the company or organization. But just as important, if not more so, that you need time to think it over, and even discuss it with your spouse( if applicable) so they can understand you will base your final decision on both monetary and non-monetary issues related to the employment offer.  And don't forget to ascertain the allotted response time given to you.

 

 

A point of Contention in PA Education

        In this commentary, I will discuss my opinion about a recent trend noticed in the PA academic sphere. Many, if not many PA programs are failing our prospective colleagues in their professional preparation to become competent, skillful clinicians. This is based & derived from my own past observations from my own past precepting/teaching experiences and occasional lecture presentations, even to practicing PAs. And w/o much fanfare, I will get to the issue at hand in my next paragraph as shown below. 

My main point of contention is that they believe that the current PA curriculum being taught has no room or need for Clinical Risk Management exposure at this stage of training. As some of their experts–as read recently in a blog– would have you believe. They hold the view that this would better serve as a post-PA school training pursuit in the form of CME through their various venues of teaching/training. 

I would disagree, and here is why: This author believes that these rationalizations are flawed given the push for adding other “nonessential” PA courses into their curriculum; namely Nutritional training and others for our students. This is one of the most common ones discussed in some PA forums. 

            This is the dilemma: they fail to see their pedagogical myopia when it comes to our students and the community at large, by dismissing teaching them how to mitigate and shield their careers from legal landmines encountered in the everyday practice of medicine. For that same reason, I am strongly in disagreement favoring a more tangible “investment in a quality education/course”. One that would have better “return of investments” sort of speak. 

I would further add, this is not only necessary but vital to develop confident clinicians in providing care in a very litigious industry, I believe that identifying and using a set of curricular Risk Management standards in this regard at the national level for PA students is more than a good idea. Not only would it mean they would feel empowered to tackle legal minefields based on sound proved risk management practices & methodologies. But moreover, it would be a step in the right direction towards ensuring sound training for all students, regardless of the particular PA program enrolled. 

I realize and wholeheartedly admit Education is a dynamic field and granted almost every change in the realm of education has a direct impact on us as educators, students, and practitioners at large. Therefore, it is important and incumbent that we be ready to accept this new paradigm and be prepared to learn and use effective new methods and techniques that would not only enhance our PA curricula but would benefit our students in their career journeys. 

With this in mind, we must always entertain relevant educational issues and seek out educational offerings that add and not detract from their careers, rather by elevating their professional development with substantive subject matter exposure topics.

The "Awoke" AMA

We are amid a global social reset. Many countries including the US are trying to become more trans-culturally transparent by attempting to discard institutionalized biases & racism from all fronts of the socioeconomic spectrum. Also, along the same vein, corporations and profit and nonprofit organizations have begun to effectively address workplace inequalities while the healthcare industry is also trying to eradicate past healthcare inequities. 

     So given that premise, we’re all embarking on crucial conversations facilitating change with elevated empathy, sensitivity, and awareness of past poor systemic inequalities perpetuated by our so-called/racist systemic myopic biases infringing on minority &/or marginalized groups. 

Multicultural health disparities & access to care have been long overdue. Removing these stereotyped attitudinal beliefs and offensive cultural behaviors will require a huge concerted effort from all healthcare industry stakeholders. Putting into practice this fresh perspective will require the AMA to go beyond lip service to the patient community & us. 

    If they want to be viewed by industry and society as a vested leading humble organization as alluded to in their newly revised organizational diversity embracing organizational policies, then they must openly recognize two fundamental needs of the PA profession/community; namely: 

1. Recognize OTP (Optimum Team Practice ) 

 2. Recognize our new professional designation–Physician Associate 

Anything short of valuing interprofessional differences or seeking ways to grow and embrace their understanding & support of the PA profession would be hypocritical. Thus, failing to collaborate in building an industry culture where nonphysician providers are not empowered to bring their whole, authentic selves to the table, nor increase access to healthcare to vulnerable patient communities is disrespectful and downright non-inclusive. And worse yet, a flagrant discriminatory practice in the eyes of many non-woke physicians/APPs.

For PAs & APPs diversity, equity & inclusivity have been more than ideas, they have been part of our professional DNA and calling when providing care to our patients for the past 5 decades. 

Will the AMA abide by its own modernized organizational policies? Perhaps…only time will tell if they are as passionate about rebuilding and maintaining a team that is representative of this new paradigm where intolerance of any form of discrimination is openly rejected & ultimately condemned.

How to Convert a Clerkship (Rotation) into a job offer

       Ever thought of converting a rotation into a job offer?  Many graduating PA-S II should begin planning their careers while there are still training. Technically speaking, what better time than when you’re rotating through a particular clerkship to make a favorable impression on a would-be employer rather than wait until after your graduate.    

     So why not get a head start now before you’re forgotten and/or lost in the shuffle? It’s easier than most students would think. But you must be willing to implement 6 actions during this time while you’re “apprenticing” as a student; all while uncovering essential information while exercising professionalism & educating yourself as a regular job-hunter would in their job search. Thus, researching the practice, employer early not only will help transition you into your 1st job but also do well in your final grade as well.

           In this article, I will share six tips from an insider that will help get your foot in the door, to land that coveted job of yours, here they are:

 Tip # 1: Be an Invested Mentee:

          Always assure them know with your enthusiastic disposition that you are willing to participate, learn and contribute from all patient presentations even as a student rather than being a passive selective observant. You must build an unforgettable positive picture of yourself by showing a willingness to be actively involved even in the minutiae of any case. Implicitly and explicitly express & remind them of your “availability” even beyond what’s commonly assigned or expected for a student in a clinical rotation. Always maintain a highly visible profile/presence. Conversely don't be a pest or dead wood.

 Tip # 2: Be an open-minded Mentee:

           Even if you think you’re not interested in a particular aspect of the specialty. Let’s say geriatric cases are very appealing to you but not doing lumbar punctures per se, then that could be a minus against you. In other words, you would be sabotaging your chances if this surfaces in the open. This would be tantamount to the “kiss of death” if you were to vocalize such disinterest or infer it to a preceptor during the rotation. Develop the attitude and mindset that you want to learn every skill possible under the sun for that or any other rotation. Minimize disqualifying yourself from potential consideration or from building your skill set early in the game. The more varied your skill set the more marketable you are when faced with competition.

 Tip # 3: Be a Truthfully Humble Mentee:

           Do not be arrogant. The difference in being confident is being aware and assured in your abilities & limitations. Especially when responding to “pimped questions” by the mentor. Even unintended non-malicious deceptiveness never bodes well with hiring potential employers.

 Truthfully, is always best to say you do not know the answer or are unsure, however, you would do your best effort to research the answer to the question posed rather than guess at the answer your preceptor is looking for. Surely you will be more respected if you know and acknowledge your limited knowledge at hand. Not knowing or being a “walking Harrison’s” is not a “crime” nor a sign of “weakness” as sometimes we’re led to believe.

 Tip # 4: Be an Appreciative Mentee:

      Grateful people are remembered fondly; so be mindful and thankful for everyone you met during the rotation including administrative staff, ancillary clinical staff, and housekeepers or operators, etc. Not expressing your gratitude for their time and/or effort in assisting you in your development is not only inconsiderate but downright the surest way to fall out of favor if an opportunity ever presented itself in the form of a job offer. The key here is to have ready and pass a few handwritten thank you cards, or a batch of homemade cookies or brownies. Nothing says “thank you” better than such a selfless gesture and token of consideration in their eyes. 

 Tip # 5 Be a Professional Mentee:

       Nowadays healthcare workers are increasingly hurried –and patients as well. This makes it easy to be abrupt, stressed out, or easily become impatient with others. Remember we’re all humans and occasionally can say or do things that may come across as inconsiderate or at worst, self-centered. The key here is to always take “the high road” when dealing with others. Respectful interactions mean treating others as you would like to be treated yourself. By conducting yourself under this philosophy you are showing your cultural sensitivity and a high degree of maturity that very few can match. In summary, being friendly towards others makes you a standout in the minds of those whose path you crossed even if they meant no ill will towards you.

  Tip # 6: Be an "Investigative" Mentee:

             Always be cognizant of the practice or organizational cultural values, strengths, and weaknesses and see if they match yours as a potential workplace you would like to be part of when starting out of school. It’s perfectly acceptable to express or demonstrate your interest in returning as an “employee”. If that’s the case, covey this during the near end of the rotation to different team members, key preceptors, and/or hiring authorities.

        “Investigate” before leaving by asking if they would consider hiring somebody with your background and personality profile. Go ahead, and submit a resume, but only if they are as interested as you are. You uncover the fact that they would be willing to consider “grooming” you once on board. Be ready with your elevator sales pitch -- to explain in 30 seconds or less your desire to join the group, but more so how would you fit in. Yet, more importantly, how will they benefit from hiring you instead of someone else. For most employers that always seem to loom big in their minds, and/or the biggest hurdle to overcome for newly minted PAs.