Wednesday, October 19, 2011


I invite anyone who might read my blog to post comments - especially feedback or questions about PAs.  I would be glad to answer anything that you'd like to know including questions about getting into PA school, what the didactic year was like, anything that has remained unanswered about the clinical year, and anything you'd like to know about clinical practice (that I can answer). 

Thanks for reading.

Sunday, October 16, 2011

So far, so good.

After 2 weeks on the job, I can gladly report that all is well. 

Last Monday presented me with a unique challenge - I had my first afternoon as the provider assigned to minor care.  Minor care is, essentially, a mini-emergency room.  Most ERs now actually have attached minor care departments - a walk in clinic for everything from lacerations, to acute infections, to traumatic injuries sustained while playing sports (generally stuff that is acute but non-life threatening).  Ours is no different from the ones attached to an ER except that we are a stand-alone facility.  We are at least 20 minutes from the closest ER, thus in our minor care we often have patients walk in with worse problems than your average family practice clinic minor care.  Crushing substernal chest pain (we're worried about heart attack here), inability to breath because of a COPD exacerbation or acute asthma attacks - these are but a few of the potentially life threatening problems we handle at our facility.  We get fractured bones of all types, and there is a rumor that we once had a patient who had sustained a gunshot wound.  We, of course, contact the local ER and stabilize these patient while paramedics are called to transport them to definitive care.  But the process of getting a patient with acute ST segment changes stabilized and ready for transport can be... intense.  I didn't have anyone complaining of chest pain, but my day was still jam packed with patients complaining of acute problems.  The patients came every fifteen minutes, some complex, some simple.  It was a busy day, the adrenaline flowed freely, and in the end everything went as smoothly as my first day in minor care could go. 

The following day was also quite challenging - I had 12 patients on my schedule.  Most were people I'd never seen before, so this requires an added level of attention to detail.  I need to essentially do a complete H&P and complete their chart notes in 30 minutes plus I have to address their chief complaint with a plan and directions for follow-up.  Generally this is a minimum 45 minute process (at least, for me it is).  So I was stacked to the rafters again.  Add to that an hour long surgical procedure in the middle of the day and by the end I was done.  I can't remember the last time I was that tired.  But it felt good to have accomplished so much.

By Wednesday I was only 6 notes behind in my charts.  I had another relatively intense day (for a new provider) in that I had to man the minor care again to see the pediatric patients coming through our doors.  Thankfully it was all straightforward and everyone, to my knowledge, was fixed up appropriately.  I have only had a few of the 75+ patients I've seen so far come back in for care sooner than the scheduled 2-3 weeks - so hopefully this means I'm doing something right.  Thursday came my reprieve. 

I was scheduled for minor care again, but since Thursday is day #4 of minor care, there are generally only a few people who seek treatment.  It was nice, slow, and nothing complex came through so I was actually done with work almost on time. 

Friday was a sweet gift straight from God (all days are, but this one was particularly sweet).  I saw just an average number of patients and all went smoothly.  I had the opportunity to leave by 3:15 (very early, which is almost unheard of).  I picked up two minor care patients - both with complaints in an area that I am very comfortable with - and was done precisely at my scheduled 5:00 leave time.  A marvelous day!

I ended the week completely caught up.  Tomorrow the cycle begins again.  I find myself not exactly looking forward to it, and hoping that it goes better than last Monday.  That said, I am not dreading the proposition and I think that this week will be a good one.  As always, time will tell. 

Saturday, October 8, 2011

Calling the shots

This past week has been an incredible week.  A year ago I posted about needing to get used to not knowing all the answers.  In the classroom, I felt confident that I had the right answer most of the time.  A year ago I transitioned into clinical learning, during which I felt confident in my abilities but remarkably uncertain about diagnoses and treatment because someone's physical being was dependent upon, in a small way, what I did - how I performed; whether or not I got the right answer.  Clinical year was difficult because of the uncertainty, but excellent in that I had a safety net - a large and proactive safety net that would essentially reach out and catch me if I stumbled.  My preceptors were there, watching over me, monitoring my decisions and consulting with me actively.  I felt uncertain, but grew comfortable with that uncertainty because that was the name of the game.  Last Monday, the game changed again.  Now, instead of having people looking over my shoulder and actively consulting with me, educating me; I am calling the shots - making the decisions - about how to treat my patients.  My patients.  These are no longer someone else's responsibility, they are my responsibility.  Yes, there are doctors, physician assistants, and nurse practitioners to consult with - and I do (especially for dermatology stuff) - but no longer do they look over my shoulder, review my charts, and guide me along actively.  Now, the safety net exists only if I activate it - if I fall but forget to turn it on, the potential exists for me to fall a long way.  And what hangs in the balance?  People.  My patients.  It is both thrilling and frightening at the same time.

I enjoyed every moment - including the discussions about whether or not to send a patient to the ER for abdominal pain, kicking myself for missing something obvious (and taking solace in the fact that I wasn't the only one), fixing children (see a previous post - but there seems nothing more wholesome than having a child come into my office sick and leave with answers and medicine that has made them feel better), and falling back on my training when certainty about the next step avoided me only to have it reveal solid answers.

I am still intimidated, but having survived my first week in the trenches I feel bolstered about the next one and ready to take on more challenges.  Uncertainty is still there, but it has served me well and I think I will grow comfortable with a little bit of uncertainty in my life - as long as I use it to the benefit of the patients for whom I am now responsible.  

Tuesday, October 4, 2011

Day #1

Rest assured - I won't be doing a post-a-day about my experiences as a PA in a family practice clinic.  But the first day was one that I will always remember - some good things, some bad things. 

It was far from perfect, but always comical - the very first patient of the day needed a procedure.  The procedure was one I know how to do and have performed several times.  I got all ready to do it - pulled all my sterile instruments, laid them on a tray.  Prepped the patient including an injection and then I realized that the equipment I had available was not correct.  Not only that, we didn't have the correct equipment for the procedure I wanted to do.  So he needed  a different procedure at a different time.  That was frustrating. 

I also made a patient cry on my first day.  It was completely inadvertent - but when I explained all the possible etiologies of her condition, it was a little much to take in.  I was quick to explain that every one was treatable, there was nothing to worry about, but we needed to find out the right cause so we could help her.  That softened the situation a little. 

And of course there was the patient who comes in for one thing, but, "Oh, by the way...."  and the problems keep on coming. 

It was a good first day...  typical.  I loved it.

Sunday, October 2, 2011

Brief Update

On 29 September I woke at 0700 to my alarm blaring.  This being the first Thursday after I had taken my boards, only one thing was on my mind: my scores. 

I rubbed a little sleep from my eyes, then immediately picked up my iPhone (the first time I have ever been truly thankful to have this little gem that allows me to use an internet browser almost anywhere, any time) and looked up my board score. 

To my utter elation, I passed.  I lay there in bed contemplating that thought....  I passed.  I passed!  I PASSED!!  I don't know that, aside from my wedding day or the births of my two children, I have ever been as happy as I was that Thursday morning.  (Yes, these four events are comparable in the amount of happy that they made me.)

I am now  Physician Assistant, Certified.  It is among the most incredible feelings in the world.

And tomorrow morning, bright and early, I begin my practice of medicine. 

The oddest thing - in two words I can sum up how I feel today: scared stiff.