Category Archives: Medicine

Michigan: A good home for the Physician Assistant

Michigan Leading the Way for Physician Assistants

unnamedWhen they asked where I was from on my first day of graduate school classes in Philadelphia my right hand instinctively shot up in typical Michigander fashion, “I’m from a city in Michigan right about here,” pointing to the middle of my palm, “It’s called Battle Creek.” My professor’s excitement was visible, she explained that Michigan was a good place for PAs to work because a new law was passed allowing greater practice authority which went into effect this year. I had known this bill: Public Act 379. It was an excellent leap forward for PAs that would allow for greater access for patients, less regulation for doctors, and fewer hurdles for midlevel providers to clear as they attempt to care for patients. My Michigan pride swelled with my classes clear admiration for these new practice guidelines. It’s as if I took a mini mental break from Philly and traveled back home, to my city, where concrete jungles were replaced with pine trees and pigeons become black squirrels, mourning doves, and bluebirds. It’s possible that during this mental break Tim Allen’s voice began narrating a new Pure Michigan commercial authored, however poorly, by me in the moment: “It’s same-day appointments, it’s providers returning the phone call, it’s scripts at your pharmacy and sick children seen not a week from today but now. It’s pregnant mothers cared for and teens educated about their health. It’s your grandparent’s checkup and your annual exam. It’s Michigan making a bold step forward for Physician Assistants. It’s Pure Michigan.”

It’s a bit wordy, I know and I’ll work with the scriptwriters when they call (I’m waiting by the phone). And if you’ve never seen one of these commercials, see the video below, it’s well worth it.

This move toward collaborative instead of supervisory language is good news for Michigan. PA students want to come here to practice which means all those benefits listed above. In addition, the timing, whether purposeful or coincidental, is similarly symbolic. This October 6th PAs across the nation are celebrating the 50th anniversary of the inaugural class of PA students from Duke University in 1967.

From just 4 students to now more than 115,000 practitioners the field was bound to experience some changes and it’s to our benefit Michigan is staying ahead of the curve. Michigan is leading the country in legislation and general support of midlevel providers as PAs all over this great state work to support families, prevent disease, have healthier pregnant mothers, and safer deliveries.

So this October, when you next visit your provider if you find yourself under the weather or the flu season has gotten to you first– take a look at the white coat of your provider, it just may read PA-C. Wish them a Happy National PA Day and then maybe say a prayer for me as I bury my head in medical textbooks for the next two more years.

 

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The Physical Exam

Recently I visited the urologist. I was getting a consult to follow up with a previous diagnosis given to me after a night in the Emergency Room. I have kidney stones. For the exam, if you could call it that, I remained fully clothed. My temperature wasn’t taken, my blood pressure not checked, I wasn’t touched by the doctor a single time, not even to shake hands.

This isn’t uncommon.

I didn’t need a physical exam, but I was in pain, I desperately wanted the Physician to check my back and the pain near my kidney. I wanted the doctor to ask about the strange symptoms I was experiencing for the first time; but she didn’t.

What is the importance of the physical exam?

Doctors of old are pictured standing over their patients, listening to the heart, lungs, and stomach, sometimes with their ear. It was a ritual of care, love, and empathy.

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The Doctor exhibited 1891 by Sir Luke Fildes 1843-1927

The painting above is titled The Doctor, and was painted by Sir Luke Fildes in 1891. In it a doctor is seen anxiously poised over a gravely sick child. His face conveys a powerful mixture of confusion, fear, and empathy. In the background we see the child’s father watching the doctor and the mother with her head on the table, her obvious despair well out of the child’s view. From the parents position within the painting we see a situation of great trust. It is the doctor, not the parents, who has the responsibility of taking care of the child.  What a profound position, a position that deserves respect.

When I volunteer at medical clinics, regardless of what the patient is there for (whether it be a cough, a rash, chest-pain, or depression) I will look into their eyes and ears, listen to their heart, and ask them to say “ahh”. Why? Because it makes them feel better, and I’ve heard enough testimonies to convince me.

Today, the patient has been replaced by a computer screen, printed test results, and x-ray images.

There is no question that our diagnostic abilities have improved. But what have we lost with the abridged physical exam? Dr. Verghese argues we are missing diagnoses, and this very well may be true. What we can say with certainty, however, is that we have lost the position of care pictured above. There is no substitute for a physician’s touch and the impact it has on the emotional and physical well-being of the patient.

Next time I go for a checkup, I’ll make sure to ask my doctor to listen to my heart and i’ll explain the weird pain i’ve had in my side, or that unpleasant symptom that has stuck around a week too long. I won’t be shocked when they seem antsy to leave and be with their next patient, but perhaps my persistence will trigger something in my doctor. Hearing about my pain might make me a little less of a test result or x-ray image and instead I will become a flesh and blood patient and the doctor will assume the position of empathetic patient advocate once again.

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