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The difference between a good and a great PA


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Hello,

 

“The good physician treats the disease; the great physician treats the patient who has the disease”

William Osler

 

2nd year PA-S here.  I recently completed my first rotation and was hoping for a discussion on what differentiates a good vs a great PA.  My rotation allowed me to work with a lot of different PAs and MDs all of whom had different levels of experience and styles of delivering care.  Because it was my first rotation most of the feedback I received was generalized (read as much as you can, remain enthusiastic, etc).  

 

Obviously a good PA is someone who knows how to do a good directed H&P and is up to date with the most current and best treatment modalities.  A lot of emphasis is also placed on "moving patients fast."  However there obviously is more to medicine than this.  I was hoping for some feedback/discussion/advice on what you all think differentiates between good and great, and what are the best practices and habits to learn early to become a better PA.

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1. experience, both before school and years on the job as a pa.

2. lifelong learning. look up every med and every disease you hear about that you have not heard of before

3. personal commitment to improvement. always have a goal over the horizon. keeps you young and keeps you sharp.

 

side note: fast does not necessarily mean good. I know good providers who are fast and bad providers who are fast.

fast can mean sloppy and poor documentation or it can mean doing a good directed H+P. your initial goal coming out of school should not be speed. that will come. focus first on a good H+P, making a good ddx, and good charting.

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I have known only a handful of truly GREAT PAs. Most of them are on this forum and I consider them mentors. What do they all have in common? An abhorrence of the status quo.

They are not content to know tomorrow what they knew yesterday.

They are not content to do things the way they were taught in training 10 or 20 or 30 or 40 years ago. They keep up. Conversely, they recognize that some old classics still work and so they use those tricks too. Newer and fancier is not always better.

They are nobody's "assistant".

They have dedicated their careers to expanding the knowledge base and elevating the reputation of the PA profession.

They are never bored.

I am glad to call these PAs my friends.

I know plenty of good PAs too, and have been happy to work with dozens, but truly "great" PAs that I know well are rare by my definition.

And who doesn't like a challenge?! :)

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2. lifelong learning. look up every med and every disease you hear about that you have not heard of before

3. personal commitment to improvement. always have a goal over the horizon. keeps you young and keeps you sharp.

 

 

 

 

^^^^^^^^

 

also

~compassion (go ahead get sick some day and see how stinky it is to access the US system as a patient)

~listening skills - if you are going to be great at one thing.... do this!  the old saying of most the Dx is in the Hx is true

~great PE skills.......  I for one am brushing up on HJR,  whispered pectoriloquy (can't even spell it yet!), egophony, and other bed side tests to help me come to a working Dx prior to the fancy lab test

~documentation - not in documenting, but instead in reading others documents - don't order that 18th CT for renal colic in a drug seeker

~know what you know and be comfortable making a decision (after 3+ years in your field for complex cases) BUT know what you don't know and how to form a great opinion/presentation to other providers

~know how to say NO - if it is not good medicine - don't do it.  IE opiates for subjective pain with no findings, benzo's for sleep every night or anxiety every day.  Patients expect for us to "do no harm" so make sure you are trying to  "do no harm"

~ability to say "I am sorry"   rather it is for running 1.5 hours late, for the loss of a loved one, or for a mistake (make sure this is okay to say with your employer, state and attorney)    patients are not looking for perfection, just to be treated well and respected.

~TOUCH the patient - yes we can figure out the majority of our Dx with a crappy fast exam, but doing a good exam shows the patient you care. I have a canned urgent care exam that takes about 4 min - people never mind it, and it shows you are looking at them

~Take care of yourself - sloppy dress, dirty jackets, poorly kept self reflects poorly on yourself - I know it sounds shallow and trite but in reality we form opinions about what we see. I am not saying $1000 suits (says something different) just clean pressed clothes.

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Have no ideas about being great, but one of the ways to differentiate between being good and very good must be the ability to listen to your patient, empathize with them (even if what they are telling you is complete BS), and convey that you care as you come up with a plan that makes sense to you and them. The ability to make your patient know that you heard them and that you care about what happens to them is invaluable.

 

I had to tell a 25 year old guy that he has recurrence of brain cancer today. Last patient of the day too. After 4 years of clear scans there was a change - he already suspected because he's had weird paresthesias and increased seizures. Surprisingly it wasn't as difficult a conversation as I anticipated because he already knew himself. We talked very practically about treating his seizures and headaches and getting him in to the oncologist and neurosurgeon. Then he cried and I cried too. Usually I'm pretty good and can keep myself together but today I couldn't. Not sure if I'm going to see this guy again but I hope in some small way that I made a difference.

 

So yeah, wear pressed shirts but most of all show your patient that you care.

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Have no ideas about being great, but one of the ways to differentiate between being good and very good must be the ability to listen to your patient, empathize with them (even if what they are telling you is complete BS), and convey that you care as you come up with a plan that makes sense to you and them. The ability to make your patient know that you heard them and that you care about what happens to them is invaluable.

 

I had to tell a 25 year old guy that he has recurrence of brain cancer today. Last patient of the day too. After 4 years of clear scans there was a change - he already suspected because he's had weird paresthesias and increased seizures. Surprisingly it wasn't as difficult a conversation as I anticipated because he already knew himself. We talked very practically about treating his seizures and headaches and getting him in to the oncologist and neurosurgeon. Then he cried and I cried too. Usually I'm pretty good and can keep myself together but today I couldn't. Not sure if I'm going to see this guy again but I hope in some small way that I made a difference.

 

So yeah, wear pressed shirts but most of all show your patient that you care.

 

JD: For whatever its worth, I bet it did make a difference ... ^5

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Have no ideas about being great, but one of the ways to differentiate between being good and very good must be the ability to listen to your patient, empathize with them (even if what they are telling you is complete BS), and convey that you care as you come up with a plan that makes sense to you and them. The ability to make your patient know that you heard them and that you care about what happens to them is invaluable.

 

I had to tell a 25 year old guy that he has recurrence of brain cancer today. Last patient of the day too. After 4 years of clear scans there was a change - he already suspected because he's had weird paresthesias and increased seizures. Surprisingly it wasn't as difficult a conversation as I anticipated because he already knew himself. We talked very practically about treating his seizures and headaches and getting him in to the oncologist and neurosurgeon. Then he cried and I cried too. Usually I'm pretty good and can keep myself together but today I couldn't. Not sure if I'm going to see this guy again but I hope in some small way that I made a difference.

 

So yeah, wear pressed shirts but most of all show your patient that you care.

You did make a difference.  I get how you feel.  Several years ago I had to tell my patient he had HIV.  It was on Christmas eve.  He cried and so did I, then he gave me a big hug. I was able to work with him for a few months in follow up and then he moved away.  Understanding humanity is a big asset to being a PA.  

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