Need advice-- Gaining Trust/Respect from Patients

[OneFishTwoFish]

Hey all,

 

I'm a fairly new grad, been practicing in urgent care for about 6 months. I wanted to get some advice on something I'm a little bothered by-- I'm female, blond, and look like I could pass for a teenager (I'm almost 30). My question for you guys is, I run into this situation several times a day when I walk into a pt room:

 

Me: "Hi Mr./Ms. _____, My name is _____, I'm a PA here. What brings you in today?"

Pt: "You're a what?"

Me: "A PA... a physician assistant."

Pt: "Oh."

 

As soon as they hear the word "assistant", I see them get nervous, stiffen up, and only sometimes ask the question "What's that?" 

 

I try to present myself both professionally and friendly, but short of stamping my age and credentials on my forehead, I'm not sure how to handle these situations. Obviously if people ask "what's that?" I happily explain. My bigger concern is those that just assume assistant = nurse or medical assistant and continue to be uncomfortable throughout our interaction but don't speak up. I'll be switching to an ER soon, and am concerned this will be an even bigger issue due to the higher pt stress and acuity. I want my pts to feel comfortable with me as their provider! 

 

Thank you in advance for any advice!!

[rev ronin]

I'm a white male in my early 40's with graying temples.  I wear a tie and a lab coat all the time, and work for an organization hat has used PAs well for decades. I've never had an issue with patients trusting me.  Stereotypes and patient expectations work in my favor, in much the same way they seem to be working against you. 

 

The one thing I do, is never say the A word.  "I'm a PA" "What's that?" (I get that maybe once a month, tops) "I have a master's degree and work for (insert their PCP name), and I will be seeing you today, including getting you to the right specialists if you need more than we can provide here in primary care".

[cinntsp]

Don't say assistant.  If you say that you're a PA and they ask what it is, just tell them you are a provider with a master's in medicine.  My patients on rotations seem happy with that answer.

[ventana]

avoid 'assistant'

 

say PA

 

Wear a long white coat, with a prominent name tag

 

younger in my career I considered doing the military way of identification - asking everyone in the office to call me PA ______   but my graying hair and advancing age sort of solved the problem.

 

I found not dumbing anything down in discussion with the patients helps - okay to use the big words and explain the medical decision making to patients

 

don't wear a teannybob hair style

 

don't get defensive on it

[True Anomaly]

You might find in the ED actually that you get LESS of it, because when someone's actually sick they just want someone to help them and they're less concerned with titles.  The guff, if it comes up, usually comes from family members rather than the patient themselves.

[UGoLong]

This is an interesting topic. Like rev, I was older when I became a PA. I have watched young women of all stripes (new docs, med students, new NPs, and new PAs) suffer from age and gender discrimination. I frankly don't think that it's what you call yourself but rather how you carry off patient interaction. It's too bad that life is like that, but it is probably best to just deal with it. It's the patient's body after all, and he or she gets to use whatever yardstick they want to decide whether or not to trust you with it.

 

(1) I don't think calling yourself a PA or a physician assistant, or a masters in medicine is the deal. It is mostly how confident the patient is in your abilities. They will size you up in 2 seconds and decide if you they want to trust you, so how you look and act is the whole ballgame. These are people who suddenly find that they are older than their doctors, policemen, etc, after a lifetime of having it the other way. 

 

(2) Be more formal and professional in your dialogue with a new patient. Dress and speak professionally. Be friendly, but don't overdo it. ("Hello", "good morning", but not "hi.") Act like someone that they should trust.

 

(3) If you're new at your job, fake it (as far as projected confidence; not by making poor medical judgements!) until you make it. If you are uncertain as to what to do, just excuse yourself and find someone with more experience to talk to.

 

(4) If someone asks you what a PA is, tell them. Don't hide what you do; be proud of it. Until they change the name of our profession, I call myself a physician assistant. I think that calling yourself by initials is just inviting someone to ask you what that means. Let's get on to their problems as quickly as we can and not waste time going through my academic and professional experience.

 

(5) Some percentage of people will want to talk with a physician instead, even if you have won a Nobel prize for medicine. Don't get pissed off; just smile and take your leave. It will happen, but not very often. In an office setting, it is amazing how many will eventually get tired of waiting for the doc and just ask to see you. And then,you will be surprised how many of them will come back and ask for you as their first choice. My SP gets a kick out of it when he walks up to a patient's room and the MA has posted a note that the patient only wants to see me!

 

If you are a young woman starting out, I would suggest you find an older woman somewhere who you can talk to about this.

 

Good luck!

[OneFishTwoFish]

THANK YOU. I hadn't considered leaving the full name out of the conversation; figured it was what we're stuck with. It's truly unfortunate that we're unable to give the full title of our name. I completely agree with what you all are saying though, and I'll definitely adopt that tactic from now on. I think the white coat will help. Didn't have one at my last place.

 

I have mixed feelings though about not "dumbing things down". I certainly try to avoid sounding like I'm incompetent, but I also think we're not doing pts any favors by using language they are unable to understand. I can't tell you how many pts say "you know, I'm just not certain what's wrong with my heart because my doctor used all that medical mumbo-jumbo". That's a failure in communication that could have been avoided. I think there's a happy medium to strive for.

 

I heard some folks are actually introducing themselves as "physician associates". I'm a big proponent of that name, but do you guys think this is an appropriate way to go if someone says "what's 'PA' stand for?"

 

Thanks again for the input.

[UGoLong]

Until we're physician associates, we're not. Why introduce a new term into the conversation that they will not have heard of? See my point (4) above.

 

I think explaining things in terms that the patient can understand is essential. You might try the official medical verbiage and then say it again in words that make sense to the patient.

[rev ronin]

Here are a couple of things patients DO ask me and my responses:

 

Q: How long did it take to become a PA?

A: Well, I had to go back and essentially added a minor in biology, since my undergraduate degree was in computers, which took over 50 semester hours and about two years.  Then after that it was 27 months of school, which was 120+ graduate semester hours. (if patient notes how much that is, continue with) Yeah, we joke that we get about 2/3rds of medical school, crammed into half the time.

 

Q: What did you do before you became a PA?

A: I was an EMT/Firefighter for five years.  I thought I was going to be a paramedic, but I went along on a medical mission trip, and after getting to hold retractors in surgery, I knew I wanted to do more than just pre-hospital care.
 

Patients have universally found these responses reassuring.

[GetMeOuttaThisMess]

Be careful about identification. Some states are quite specific as to how it is to be handled. Texas requires name and title of "Physician Assistant" to be displayed on either coat, scrubs, or name badge. Bottom line, no magic answer other than a confident approach and experience.

[Guest Paula]

From the older woman perspective:  (Gosh, I hate calling myself an older woman, but reality stares me in the face every morning as I look at my crow's feet).........

 

If you have a girly, high pitched voice, learn to use your mature adult woman voice.  Wear appropriate clothing which includes the white jacket, nothing low-cut or too short. (I am still surprised when I see female providers having their cleavage showing and it is a distraction).  Wear appropriate make-up that might make you appear a little older.  

 

As far as the PA title:  You will figure out what works for you and I agree with what has already been stated above.  Do not mis-represent yourself in any way and check your state laws.   I usually just call myself a PA but have at times explained it if asked by saying:  A PA is  a physician assistant who has a masters degree in medicine.  I work in collaboration with Dr. X.   and then I focus the rest of the conversation on the patient's issues.

 

I started this career in my late 40's so I did not have a problem with being taken as the professional medical provider and that is the beauty of age.

 

 One of my SPs in my first job at an Urgent Care/ER was newly out of ER residency, short, very petite and young looking, with a soft voice.  Her first year was hard, especially with the elder crowd thinking she was a nurse.  She even had some trouble with the older male ER docs.  She proved herself competent and was soon named the ER director and over all of us including the other docs.  It was interesting to see her develop her own style and  always was a pleasure to work with. 

[wjm7]

This is an interesting topic. Like rev, I was older when I became a PA. I have watched young women of all stripes (new docs, med students, new NPs, and new PAs) suffer from age and gender discrimination. I frankly don't think that it's what you call yourself but rather how you carry off patient interaction. It's too bad that life is like that, but it is probably best to just deal with it. It's the patient's body after all, and he or she gets to use whatever yardstick they want to decide whether or not to trust you with it.

 

(1) I don't think calling yourself a PA or a physician assistant, or a masters in medicine is the deal. It is mostly how confident the patient is in your abilities. They will size you up in 2 seconds and decide if you they want to trust you, so how you look and act is the whole ballgame. These are people who suddenly find that they are older than their doctors, policemen, etc, after a lifetime of having it the other way. 

 

(2) Be more formal and professional in your dialogue with a new patient. Dress and speak professionally. Be friendly, but don't overdo it. ("Hello", "good morning", but not "hi.") Act like someone that they should trust.

 

(3) If you're new at your job, fake it (as far as projected confidence; not by making poor medical judgements!) until you make it. If you are uncertain as to what to do, just excuse yourself and find someone with more experience to talk to.

 

(4) If someone asks you what a PA is, tell them. Don't hide what you do; be proud of it. Until they change the name of our profession, I call myself a physician assistant. I think that calling yourself by initials is just inviting someone to ask you what that means. Let's get on to their problems as quickly as we can and not waste time going through my academic and professional experience.

 

(5) Some percentage of people will want to talk with a physician instead, even if you have won a Nobel prize for medicine. Don't get pissed off; just smile and take your leave. It will happen, but not very often. In an office setting, it is amazing how many will eventually get tired of waiting for the doc and just ask to see you. And then,you will be surprised how many of them will come back and ask for you as their first choice. My SP gets a kick out of it when he walks up to a patient's room and the MA has posted a note that the patient only wants to see me!

 

If you are a young woman starting out, I would suggest you find an older woman somewhere who you can talk to about this.

 

Good luck!

 

This seems like very sound, reasonable advice.

[Gordon, PA-C]

Here are a couple of things patients DO ask me and my responses:

 

Q: How long did it take to become a PA?

A: Well, I had to go back and essentially added a minor in biology, since my undergraduate degree was in computers, which took over 50 semester hours and about two years.  Then after that it was 27 months of school, which was 120+ graduate semester hours. (if patient notes how much that is, continue with) Yeah, we joke that we get about 2/3rds of medical school, crammed into half the time.

 

 

Actually it is 4/4 of medical school crammed into 1/2 of the time.  We cover exactly teh same subjects as the MD students do.  Plus our clinical rotations are MUCH more in depth and demanding than the med students.  We get a lot more clinical hours in rotations than they do.

[problem child]

most people know what a PA is. besides, when they checked in, or made the appointment, they were told they would be seeing the PA. or if they weren't, they should be. so maybe educate the front office staff on clarifying with patients who they are seeing.

 

and this might sound like strange advice, but rather than go in saying, "what brings you in today?", look at their chart and KNOW why they're coming to see you. then you go in and say, "hi mr. smith, I see you've been having headaches. let's see what we can do for you".

 

patients feel more confident with their providers if they know they are dealing with someone who has a bead on them from the get-go.

[Guest JMPA]

I tend to keep my anwers brief when a patient asks what a PA is. My simple truthful explaination in one sentence is "I practice medicine under the supervision of a physician".To the OP, may i suggest that you, without implying to you directly, to adopt a mentality of practicing medicine rather than assisting physicians. New graduates have a tendincy to act like assistants until they reach some sort of awakening. I too fell into that category initially many years ago, and until i had awoke, i had to deal with a lot of disrespect from patients and providers while learning the ropes which added much more stress. Now i command respect through my clinical skills and actions. My sp whom is many more years out of medical school doesn't hesitate to ask my opinion on select cases. its not about the age, partly about the dress, but mostly about the attitude. good luck

[Febrifuge]

I also work in Urgent Care. In fact, I do evenings and weekends, and I'm the only person seeing patients in the whole building when I'm working. That tends to lend some credibility, probably: I am it.

 

My introductory spiel (as a bald early-40s guy) is like so:

 

"Good evening, I'm (Febrifuge), I'm a PA, I run the urgent care about half the time in the evenings and weekends."

 

When peope ask "what's a PA?" ...which by the way isn't terribly often, just often enough for me to silently curse the AAPA, I answer "Physician Assistant, sometimes Physician Associate. Same thing either way." Like my line about running the urgent care, it's true, but it puts the focus where I want it, and it helps impart a sense of legitimacy and respect.

 

For some reason, my practice group decided my name tag should read "Physician Asst. Cert." so I probably get some bonus out of people who see the one full word there is "Physician." I do correct everyone who calls me "Doctor," the first time they do it.

[Febrifuge]

and this might sound like strange advice, but rather than go in saying, "what brings you in today?", look at their chart and KNOW why they're coming to see you. then you go in and say, "hi mr. smith, I see you've been having headaches. let's see what we can do for you".

 

patients feel more confident with their providers if they know they are dealing with someone who has a bead on them from the get-go.

Agreed. I take 5 minutes to flip through the chart (well, scroll, as we have EMR, but same thing) and I always chat for a second with the LPN who roomed the patient. Then I say something like "here's what I think I know, so far; let me know if there's more to it, or if any of this is off." I want the patient to feel like they're being taken care of by a team, and I don't want them frustrated at having to give the same information over and over again*.

 

 

* unless I want to hear it in their own words, something isn't clear to me, or the patient is avoiding directly answering history questions.

[cbrsmurf]

I always introduce myself to new patients as "Hi, my name is cbrsmurf, I'm a physician assistant."

 

I don't feel like I have to hide what I have earned, nor do I feel a need to misrepresent myself.  I think I've only one patient in the last year and a half of practicing say they wanted to the physician instead.  I am guy, I look pretty young (although I feel like I have plenty of gray hairs coming in), and I get some the same reaction as you (the original poster).  I don't know everything and I never will, but I feel as though I give my patients as much help as I possibly can, promise them I will get them the answer and best care, and most of them appreciate it.

 

Of course, there are always going to be some people that won't come around no matter what you do.  To those people: f*ck them.

 

 

 

 

 

 

 

Just kidding: I tell them I can schedule them with the Dr the next time and will make sure to go over their visit/info with the doc.  I believe patients have the right to see whoever they want.

[Guest Paula]

I also work in Urgent Care. In fact, I do evenings and weekends, and I'm the only person seeing patients in the whole building when I'm working. That tends to lend some credibility, probably: I am it.

 

My introductory spiel (as a bald early-40s guy) is like so:

 

"Good evening, I'm (Febrifuge), I'm a PA, I run the urgent care about half the time in the evenings and weekends."

 

When peope ask "what's a PA?" ...which by the way isn't terribly often, just often enough for me to silently curse the AAPA, I answer "Physician Assistant, sometimes Physician Associate. Same thing either way." Like my line about running the urgent care, it's true, but it puts the focus where I want it, and it helps impart a sense of legitimacy and respect.

 

For some reason, my practice group decided my name tag should read "Physician Asst. Cert." so I probably get some bonus out of people who see the one full word there is "Physician." I do correct everyone who calls me "Doctor," the first time they do it.

Good thing they left the t on at the end of Physician Asst. Cert. nnnLOL!

[wjm7]

Actually it is 4/4 of medical school crammed into 1/2 of the time.  We cover exactly teh same subjects as the MD students do.  Plus our clinical rotations are MUCH more in depth and demanding than the med students.  We get a lot more clinical hours in rotations than they do.

 

This is the sort of statement that makes PAs look like cocky, arrogant idiots.  It's just plain laughable.  I'm astounded that someone could think this.  4/4 of medical school in 1/2 the time.  You MUST be kidding.

[cinntsp]

 

(4) If someone asks you what a PA is, tell them. Don't hide what you do; be proud of it. Until they change the name of our profession, I call myself a physician assistant. I think that calling yourself by initials is just inviting someone to ask you what that means.

 

You may want to consider that they don't ask you what it means when you say assistant because they already know what a medical assistant is. If they're impressed it's because they thought you could only give shots and take vitals. Hmmm...

 

Sent from my Nexus 5 using Tapatalk

 

 

[UGoLong]

I've never been confused with an MA.

 

It's not your title that makes you who you are: it's who you are that makes you who you are.

[winterallsummer]

A lot has to do with how you walk in and talk to the patient.  You have to walk in with confidence and at least appear to be in charge of the situation.  Maybe try raising/projecting your voice a bit, even acting just a little bit cowboyish if you get me.  Good eye contact, a firm handshake, and sit in a way where your body language projects confidence.  If there's another person in the room, shake their hand too.  You cannot be too friendly with some patients.  Sometimes you have to sort of be "the boss", if you get what I'm saying.  Some pts yearn for that patriarchal relationship where the "doc/PA" just tells them how it's going to be.  Others will appreciate you coming to them as an equal.  You have to gauge as you go and adjust.

 

Anyway, when asked what a PA is, I fully agree to give the name physician assistant and educate them a little bit.  However I would recommend introducing yourself as a PA, not the full name.  Anyway, I'm just a 2nd yr student, but hope this advice is helpful.  The majority of pt's I've worked with assume I am the same as a doctor, although I have been mistaken for a nurse before.  The ones who know what a PA is are usually those who are fairly sick, or care for a sick parent, and go to a myriad of specialists where they typically see several PAs (eg almost any pt with managed CHF will know what a PA is, from my experience).

 

As far as explaining things, I don't agree with give technical jargon that confuses the pt.  If you do, fine, but then explain it with a metaphor... eg "you do have to take this BP med everyday, because it prevents atherosclerosis which is a catalsyt for heart disease; in other words, this BP keeps your pipes from getting too much gunk in them.  Even though you don't feel the gunk, if we let it build up, it's going to block your pipes completely."  You get the idea.

[primadonna22274]

Just once I would love to see Gordon flunk step 1 USMLE or COMLEX. You keep spouting this stuff and you have no idea what we learn in med school that PAs don't learn. The difference is step 1--it may not matter that much in the end but the truth is we don't teach this stuff in PA school. A PA with a basic science PhD could pass it with significant self-study but other than that just STFU and get back to the topic on hand.

[Febrifuge]

I, uh, I think you meant that for some other thread... (cough)