A Delayed Introduction

Being a fairly new Physician Assistant means that I make a lot of introductions. I have been spending quite a bit of time introducing myself to physicians and nurses, a variety of other co-workers, and--of course--patients. I've pretty much got it down, so let me introduce myself to you, my beloved reader:

I am an Emergency Medicine Physician Assistant who works in Chicago, and one who enjoys his time spent in the ER, busy as hell managing anything from stubbed pinky toes to heart attacks. I also have a small following of patients that see me at a Chicago family practice clinic. Whether it be in the ER or in the clinic, I keep my eyes open for ways healthcare can be improved for the patient. That is, in essence, the purpose of this blog: to identify ways that the patient can benefit from healthcare policy changes, new technology, or research.

In my last post, I suggested that the final (largely missing) piece to the team-based approach to medicine is the emphasis on the patient. My reader, whether you are an attending physician or an ordinary citizen, you have been a patient at some time, and as a clinician, I value your insight.

Throughout the blog, I will occasionally be asking for stories of your experience with medicine. Did you have a particularly good or bad experience seeing your healthcare provider? I'd like to know what made it so great (or not-so-great). Have you seen some new technology or research that is bound to change the world of medicine? I'm also interested in seeing it. Email me at pahealthperspective@gmail.com.

I cannot promise that my posts will always address medicine, but when they do, it will certainly be from the perspective of a PA, or the way a provider looks at healthcare. I also hope to provide a point of view that comes from the patient; after all, I too am a patient. Ideally, by exploring both sides of healthcare, we can jointly find an elegant solution that both makes the provider and patient happy.

Happy reading,

Alexander

The New Healthcare Team

I've noticed that a few of my Physician Assistant colleagues are worried that physicians are losing their interest in working as part of a team. This is a reasonable worry. Since the formation of the PA profession, PAs have long stated that healthcare is best delivered with a physician-led, team-based approach. With potentially declining physician support for this team-based approach to healthcare, the PA profession may be at risk. I do not feel this trend is present; I believe that utilizing a team-based approach to healthcare will actually become more popular, culminating with the inclusion of the patient as the newest member of the patient-centered healthcare team.

Although formal research is sadly lacking in describing the benefits of physician-PA teams, literature on the subject is not completely missing. For example, the American Academy of Family Physicians (AAFP) and the American Academy of Physician Assistants (AAPA) recently released a detailed report describing the important role of physician-PA teams. The report is very supportive of physician-PA teams, and stresses that advances in medicine ought to focus on developing this relationship, not dissolving it. Even more recently, the AOA (the governing body of osteopathic physicians) released a very similar statement with the AAPA regarding the same issues. Finally, the AMA has a short statement supporting physician-led, team-based healthcare. Although there may be some physicians that do not prefer team-based healthcare--or perhaps even disagree with it--several major medical academies support the notion. 

Perhaps a more important factor to consider is simply that the idea of a healthcare team has not been around long enough to make a clear impact. In fact, PAs themselves have only been around for 50 years. For the first several years after a new profession is created, that profession remains fairly unknown. As with many other new health professions, PAs were (and still are!) fairly unknown. I spend a substantial portion of my introduction describing to my patients what a PA is, and how we are different from physicians, but still provide high quality medical care. But, popularity and support grow with time. Consider the practice of osteopathic physicians (DOs): it took nearly 100 years before DOs were commonly seen in medicine, and it wasn't until 1969 that the American Medical Association granted DOs the privilege to practice medicine legally in the United States. It is possible that the PA profession is on the cusp of reaching that critical mass that will push them into the public spotlight. If we double the short 50 year history of the PA profession, PAs will be seen to play a much greater role in healthcare delivery. PAs will become much more prevalent in medicine, much like our DO partners. 

But the proof of PA success is in the pudding: statistics supporting PA growth are almost impossible to avoid. Forbes, Money and several other magazines have all published articles detailing the incredible growing need for PAs and how PA degrees are some of the best Master's degree to obtain. Furthermore, in two recent polls of physicians, PAs were found to be the preferred professional to work with when delivering healthcare (and the June 2013 issue of The Hospitalist). The evidence is in, and not only are physicians interested in a team-based approach to medicine, but they prefer to work with PAs.

The final aspect of a proper physician-led, team-based approach to healthcare, such as the ones described in the AAFP and AOA papers, is including the patient as a part of the team. Far too many times have I seen doctors or my colleagues lecture a patient for doing research into their own disease. The patient is almost scolded for researching their own ailment, and bringing in papers that support what they think they have. In a physician-led, team-based approach to medicine that ultimately benefits the patient, the patient should play a central role in their own healthcare. Rather than griping about how patients don't know enough about medicine to help in the decision making process, include them. There is an old adage about medicine: "if you listen carefully, the patient will tell you the diagnosis." I suspect, if a patient feels they have a particular disease, the provider should carefully consider it. The patient's training may not be to that of a physician or PA, but they may be on to something. And, in the worst case, the patient's idea only serves to expand the differential diagnosis. Include your patient as a part of the team. A physician-led, team-based approach to healthcare is nothing without the strongest emphasis on the patient.