Saturday, November 27, 2010

A PA's Perspective on the Future of Medicine

The rumblings are getting louder.  The undertow is getting stronger.  It seems every medical team member is unhappy.  The hospital administrators are trying to cut down on costs, the government is trying to change the health care in the U.S. over to a nationalized system (quantity and quality unknown at this time), the physicians have left primary care in droves, the NPs are trying to say they can totally take the reigns of primary care over, and the PAs are trying to determine a new name for themselves. Why is everyone so unhappy?  Could it have something to do with our own unmet needs, or our perception that others are trying to be more than they are, or our misunderstandings of how healthcare is administrated, or deceiving ourselves into thinking that we can do more than we are trained to do, or of feeling as though we are not perceived correctly by patients, the public we have taken an oath to provide care to?  Or maybe it also has to do with the overseers of healthcare, those giant insurance companies who we believe are being greedy and not responsive to our patient’s needs?
First, let’s take a step back.  Let us take an honest look at who we are and what we all bring to the table. 
Who are the hospital administrators and what do they bring to the table of health care?  They are those people who are responsible for taking care of the bottom line, the financial line of the hospital.  Yes, they have to make some decisions which are not pleasing to us, the healthcare providers on the frontline.  Yes, they have to cut nursing staff, or say ‘no’ to our budget increases, or say ‘no’ to the hospital buying a new CT Scanner.  But we have to remember that they are there to keep an eye on the bottom line of the hospital so that it can continue to stay open and over time grow. 
Who and what is the government plan regarding healthcare?  There’s still too much we don’t know about Obama’s healthcare plan and potentially it still can be changed.  So what should our response be to it?  We need to be ready to change, plan, participate and be responsive to it, remembering that we are not in control of it.  But our patients are going to be affected by it, We need to be there to help them through the various gates. 
Then there are the physicians who have left primary care in droves.  They have decided that being a specialist is where the money is, and who’s to blame them when they come out of medical school with huge debts.  They deserve to have a life they have spent years in training for. 
Then there are the NPs.  Where do we start?  The physicians are upset at them for their believing they can take over primary care and for their believing that they don’t need to collaborate with the physicians in taking care of patients.  How wrong can they be?  First off, the NPs (whether they want to admit it or not) are not well enough trained to take over primary care for patients.  They don’t have the education or the clinical experience to take care of ALL of the patients who come into a primary care setting.  And until they are capable of doing so, they cannot say, or believe they can step into these shoes.  The shoes are too big to fill.  They need to quit fooling themselves in believing otherwise.
Then there are my PA colleagues.  Yes, we need to change our name so that the media and patients perceive what we do appropriately.  But in reality there is more.  We need to step up to the plate, take the helm of leadership onto our shoulders and truly help our colleagues in shaping the future of medicine.  Now is our chance to bring about the necessary changes for our patients.  Now is the chance to bring about compassionate care.  Now is the chance for us to shine.  And for us to shine, we need to strengthen our relationships with our physicians, not weaken it.  They need to know that we truly are team members in every way.  We are there to work together for the betterment of our patients. 
Our patients need the skills, experience and education of both the physician and us (whether that is the PA or the NP) involved in their healthcare.  They need both of us involved in taking care of them, seeing them in clinic, seeing them as a hospitalized patient, ordering their medications, assessing their response to treatment.  We all have something to bring to patient care, we all have certain expertise.  Just as two strands of rope intertwined together is stronger than a single strand alone, so are we acting as team members for our patients.  Standing alone we can never be as good as standing together. 
Let us respect each other.  The physicians need to be respected for their training, expertise and education.  And due to their training and education they have earned the right of being the ‘leader’ of patient care.  Why can’t we all act as a team?  Let’s all take the reigns of leadership (that do belong to us) and move forward by forming ‘patient homes.’ This is the future of medicine. 
Being involved in ‘patient homes,’ is the wave of the future with primary care.  If done correctly, ‘patient homes’ allows everyone to put forth information regarding a patient, for the betterment of the patient.  Everyone acts as a team member (this includes the physician, the NP/PA, the social worker, the psychologist, the clinic nurse, etc.) But for the patient home idea to work, we need to put our egos aside and respect what everyone (and I do mean everyone) can and does bring to the table of healthcare. 
Let’s stop this antagonist attitude we have towards the physicians.  Let’s stop the backbiting and bullying the NPs have towards their nursing colleagues.  Instead let’s appreciate what we do have, appreciate what we can bring to the table of healthcare.
Let us start now.  Start with respecting our colleagues and start with laying down our egos.  Let us begin tomorrow with an attitude of teamwork.  And let’s do it now for the betterment of every patient we see.  Then and only then can we bring about the future of medicine in ‘patient homes’ all over the country. 

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