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| Reality #3----We Are Not Alone |
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by Bob Blumm, MA, PA-C, DFAAPA - June 21, 2010
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Sci-Fi enthusiasts will remind us that this universe has other intelligent life capable of creating, thinking and controlling their environment. These individuals will state that we are not entirely unique; that we are not alone. The Physician Assistant profession does not stand alone in this decade of the 21st century. We are a known entity and have “history” and have proven ourselves in the fields of medicine and surgery but we are not unique. Think for a moment of the scores of other medical professionals that have similar knowledge and abilities that are similar to ours. A diamond has many facets, and all of the facets combined create the brilliance that makes it among the most sought after gems. Any jeweler will expound on what makes a jewel valuable, and this is why we seek out that “something special “ when we approach our future mate and pledge our love, commitment and trust. When we consider the art of caring for the sick, the best gemologist is not the physician or the senior PA; rather, it is the patient. The patient is the entity that embodies the emotions of fear, disbelief, frustration, disillusionment and vulnerability. It is my strong belief that the patient has the ability to discern the professionals that truly care for their conditions although they lack, in most cases, the ability to quantify the scope of knowledge and skill of the provider.
This past week I had the wonderful opportunity to be on the other side of the examining table and to be the patient in a hospital for four days. There is nothing like placing on a “Johnnie coat” and observing firsthand what it is like to be on the receiving side of the medical system. When I started this composition, I stated that we are not alone, and the reality of my comment rests in the responsibilities of the other providers that are responsible for aspects of our health care. I walked into a superbly clean and modern hospital in NYC and was whisked through an admitting process because of the competency of the Nurse, secretaries and physician who were responsible for my care. I had the advantage of having a “world recognized expert” as my personal cardiologist but realize that he does not work in a vacuum. The “attending” makes a diagnosis and orders tests and has a treatment plan that is modified by the results of the testing but eventually that person leaves this center of learning and the patient becomes part of the “system.” Our system is far from flawless and we are subject to the protocols that establish the standards of care within an institution.
I had an extremely concerned and competent nursing staff and developed a fondness for my favorites which inevitably were the nurses that demonstrated personal concern and stopped by to offer cheery support and words of wisdom. The nursing assistants performed their tasks with the abilities that were passed on by the nursing education department and the Nurse Manager. Whether the provider was a food service employee, technician, housekeeper, respiratory therapist or the professional nurse that was part of the echo lab or PACU staff that helped in performing cardioversion, I felt surrounded by competence and concern. I was astounded by the fact that every caregiver used the hand cleanser on the wall before and after treating each patient and utilized gloves for every task that was performed, from personal patient care to removing food trays. This hospital was a stellar example of a 21st century medical center that has been well-versed in the current standards that prevent cross contamination and create the nightmare of nosicomial infections that inhabit many of our hospitals. The “let down” was that the same standards did not proliferate the ranks of Interns and Residents.
I sound somewhat distracted but I am slowly moving to my point which is that healthcare is delivered by a team and that the standards of that team need to be similar to have positive outcomes. The team has physicians, Interns, residents, PAs, NPs, therapists, technicians, nurses, and also consists of electricians who provide safety for the high tech equipment that we utilize, housekeeping who prevent the accumulation of vectors of potential infection, food service employees who are tasked with developing diets and distributing the proper diet to the appropriate patient. From lab techs to floor secretaries, all are part of a team. When we look at specialized care that is normally delivered by advanced clinicians we are confronted with the fact that all of us share similar knowledge but serve it in a unique manner. Everyone is taught to perform an assessment of the patient which includes a perfect H&P, yet I did not have a PA or NP involved in my care and the young Interns that were responsible for my H&P only provided approximately 7% of their responsibility. Even if their responsibility was to perform a focused exam they were totally indifferent, incompetent and lacking in the rudimentary aspects of an examination. Perhaps it was because of the discipline of the service or the lack of concern of the more experienced physicians, but basics were totally neglected.
We are living in a world that values and focuses on competition and a standard of care. NPs and PAs perform similar tasks yet I do not compete against the other professional. I am not competing with other PAs by trying to demonstrate my specialized knowledge. I am competing with myself, my former knowledge and competence, my standards, my combination of both experience- and evidence-based knowledge that has been formulated in my life by discipline, daily searching of web sites and medical news flashes and the desire to provide a safe, positive and healing experience for my patient who ultimately will say that their best health care provider was “that PA who looked like Santa Claus.” This is the best promotion and marketing of our professions, the carefully thought out approach to each individual and their specific needs with positive outcomes. Administrators and Chiefs of Departments and Services hold in their hands the Gainey Surveys, the infection control statistics, the letters of commendation and the M&M reports that demonstrate our competence and our failures. Our personal goal needs to focus on our personal best and the acknowledgement that we are not alone, that we are part of a team and that our main responsibility other than delivering excellent health care is to strengthen one another and to evaluate our personal knowledge and competence by sincere reflection enhanced by continued education and commitment to those sacred words: “Do No further Harm.”
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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