It’s Complicated

Today started off beautifully. I sailed through traffic with nary a hiccup or police officer glancing suspiciously at my lead-footed progress, managing miraculously to get to work early enough to sip a cup of tea since the first patient of the day hadn’t shown up. It then rapidly progressed downhill.  He did end up showing up 20 minutes late, and though a very nice man and fascinating to talk with, possessed a medical history complicated enough to make him the interesting kind of patient you never want to be.  My next patient showed up early, and being now already behind, had an even more complicated history, putting me another 30 minutes behind. The next patient was on time, but because I was already running late, got picked up 35 minutes late, and he and his daughter had a million questions, all of them asked with upraised eyebrows, furrowed 11’s masking the concern that I would be yet another person to deflect and dive away from the hard questions.  They were not angry with me, but I am the face of a system of bureaucracy maligned by the media, painted with the wide tar brush of suspicion from so many other whispers of incompetency, and I’m the target sitting there available. These are the patients I take as personal challenges to rebuild the trust that has been damaged. I answer as many questions as thoroughly and honestly as I can, and when they leave, they both hug me. I take a deep breath, than head to the next patient. These are the days I feel like I’ve sprinted the entire day, throwing food towards my growling stomach in between patients, and arriving at the end of the day, out of breath, out of words, and knowing the marathon is not yet over, and it will begin again the next day.

So, why do I do what I do?  Why be a PA, when medicine is not a science,  we don’t have all the answers, health care costs increase every day,  and people mistake me for the med tech when I call their name at the door of the waiting room? Why work at the VA, when as a PA there are jobs available all over the country in any other environment I might be willing to work in?

It’s complicated, as they say in Facebook lingo.  As a PA, I’m privileged to witness some pretty incredible moments: When a patient feels comfortable enough with me to share her story of military sexual assault for the first time ever, and I’m able to navigate all the protocols to get her seen by a psychologist that day. When an observation I make as part of my routine physical exam helps a patient finally get to the crux of what’s causing his headaches. When a long-time smoker tells me he finally is going to quit because today’s combination of advice and his journey to get to this point happened to coincide. When today a patient promises not to hurt himself or others, and I believe him.  When stories of helicopter pilots, TDYs to Micronesia, and military couples married for 48 years weave in and out of a patient’s narrative. These are the blessings and victories that get me through the sprint to the end of the day. These are the reasons I feel blessed to be a PA taking care of veterans.

We call it practicing medicine for a reason.  It is impossible to know everything in medicine.  The rate of knowledge we are acquiring about the human body is mind-boggling, but nowhere near comprehensive. And every day, “truths ” are revealed as falsehoods. As a PA, I feel free to admit I don’t know everything, and as a PA I am so glad my adopted state and my home state of Michigan allows me the freedom to practice to the top of my licensure. I don’t practice medicine in a vacuum, and don’t know anyone who does. We could not exist without our team — other PAs, nurses, collaborating physicians, med techs, pharmacists, respiratory therapists, psychologists, social workers …the list is long, but for anyone to say they know and can do everything for a patient, that is hubris, plain and simple. I’ve been blessed to move into a new position and am learning so much about leadership and all the fascinating behind-the-scenes mechanisms that run the largest healthcare system in the world, which just makes my nerd-self happy, but also makes me grateful for those in administration who do that thankless work without the gratification I get from my one-on-one time with my patients. I’ll never give up clinical medicine for the administrative stuff,  but the knowledge I’m gaining is making me a better clinician and advocate for my profession. 
Tomorrow is the start of PA week which runs from 10/6-10/12. It marks the 50th anniversary of our profession. The first PAs were Navy Hospital Corpsman who had a wealth of knowledge and experience coming out of the Vietnam War. Dr. Eugene Stead recognized it would be a waste to let that expertise slip away, and created the PA profession based on fast-track training for WWII physicians to fulfill healthcare shortages that continue to this day. This also echoed a similar earlier concept found in Russia known as the feldshers.

Now PAs work in all branches of medicine in all the states and territories of our nation. The concept has spread to Europe and Australia. You can find PAs not just in hospitals and clinics, but also in schools, back on the battlefield, in the boardroom,  in publishing fields, pushing boundaries in research, in front of the classroom and getting MBAs. 

Today I honor those first PAs who blazed the way for the rest of us, the doctor who had the foresight to sees PAs as valuable members of a healthcare team, and the mentors who pushed us all to aim higher. Here’s looking at what we can achieve together in the next 50 years!