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| It’s Really Quite Simple—Nothing is Simple in Medicine: A Physician Assistant Explains the Importance of Trust |
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by Bob Blumm, MA, PA-C, DFAAPA - August 12, 2010
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I have been fortunate enough to have had the same partner or supervising physicians for the past 38 years. How many marriages last this long, and we are like the Eveready battery; we’re still going. Perhaps one of the secrets to our longevity is both honesty and communication. In all these years on three occasions when we disagreed on a procedure he finally told his persistent PA, “Bobby, I’m the surgeon!” When he pulled rank, I stopped my debate, as there really is a time and a place for submission. On another occasion, he overheard me mention to a patient that the contemplated procedure was “easy.” We spoke at the end of the morning and he mentioned that there is no such thing as an easy procedure; they are complicated and we may make them look easy but they remain fraught with potential problems. Besides, who would pay for an “easy cosmetic procedure?”
You and I, as NPs and PAs, have the wonderful opportunity of being trusted with caring for those who occasionally find themselves sick. Sometimes we are engaged in fighting disease whereas, at other times, we are dealing with alleviating symptoms. Many argue that caring for some of these signs and symptoms is simple. An intensivist or cardiac PA or NP may feel that, in comparison, the person who works in a retail clinic is dealing with dumbed down medical problems and are, in comparison, required to use little scientific knowledge to cure their patients. In reality, as a person who started a retail clinic network on Long Island and hired thirty people to perform their jobs, it is sometimes more difficult to treat a cough than it is to treat a pneumonia. Let’s take a moment and look at the 47 y/o male who presents with a cough. What type of information do we require or what questions do we need to ask to differentiate this “simple cough” from a lung cancer, COPD or CHF?
When did your cough begin? Has it become better or worse over the past week? Is it productive or non-productive? Is it a dry cough or a hacking cough? Is it a sporadic cough or a nagging, straining cough? Is it painful, and does it radiate to other parts of your chest wall or back? What makes it better or worse? Have you had relief from cough medicine or lozenges? Have you taken OTC medications, or has your healthcare provider written a prescription for a cough suppressive medication, or perhaps have you used another family member’s medication? Do you have other medical problems that may be responsible for the cough such as sinusitis or a post nasal drip? Do you cough up phlegm, and, if so, what color is it: white, yellow, green, rusty colored, clear? Does your coughing make you feel like vomiting? Is the mucus very thin or is it thick enough to obstruct your airway? Do you smoke, or have you recently stopped smoking?
Some astute clinicians who deal with this problem more frequently than I may ask more questions, and then there is the need to perform an ENT exam, examine the posterior pharynx, auscultate the lungs and, if you are an older clinician, perhaps percuss the lung fields. A cardiac exam is appropriate as well as asking if the patient has become incontinent of urine when coughing. One set of symptoms may lead to other sources of infection or other isolated medical problems. In conclusion, I sign off with the title of this essay: It’s really quite simple - nothing is simple in medicine.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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