"When do I get to see the 'real' doctor?"

[Noreaster]

One thing I've noticed at my new job, the support staff are awesome. The medical assistants where I am have a healthy respect for me, which is huge. When they bring a pt into a room, they tell the pt in a professional way that Mr. sos-and-so is going to come in to see them. I really think that the fact that they don't just use my first name and their professional tone really helps the patients feel as though they're seeing a provider. Every little thing helps, right?

[MadelinePAC]

If one works in an office setting it is good for the office staff to tell the pt making an appointment that they will be seen by PA so and so. I have been going to same physician's office for 13 years. When I call they say: Is it ok if you see the PA? Now the staff knows I am a PA so we laugh about it. I have been seeing the same PA and doc for 13 years, in fact, I decided to become a PA from my interactions with the PA at the office.

I see a gyn NP. My first appointment I coudn't wait three mos to see the Doc so they offered me a 2 week wait to see the NP. I love her too.

But is important for the pt to know ahead of time.

We do not have that luxury as hospitalists to the rhetoric becomes exhausting.

[Noreaster]

I couldn't agree more with knowing about the appt. with a PA ahead of time. At times--more so where I used to work--I'd walk in to an exam room and introduce myself and the patient's face falls with that look that had become all to familar. That face often followed with, oh, but I thought I was seeing Dr. so-and-so... Once the patient is at this point it's really hard to have an optimal experience.

[Guest lakejl]

Who cares? My ego ain't that big, its just less people for me to see. I smile and say, "no problem, he'll be with you in an hour or two." I work in a busy ER and there are tons of other things that I can be doing. It never fails that they will get tired of waiting and ask to see me. It is then that I am at my most professional, polite, and competent. Almost always they are exceptionally pleased by my care and even recommend me later. I only had one patient that demanded to see the MD after I saw them. She had a fender bender and "norco 10 worked well for me in the past." She asked if she could have and RX for norco 10 and I said "absolutely not." I then wrote her an antiinflammatory and muscle relaxer. She then demanded to see a "real doctor." My supervisor, god bless him, walked into the room later. He said that he had the utmost confidence in me and would follow my plan of care. She stated that I gave her motrin and flexeril and that was not sufficient. He said that "mr lake is pretty generous, i wouldn't have given you anything." She soon stormed off.

 

Life is too short and the job too demanding to let petty things ruin your day.

[Guest Cooper]

 

Life is too short and the job too demanding to let petty things ruin your day.

 

Amen to that!

[Guest OnBelay]

I'm not a PA yet but have seen this happen at the clinic I work at. I'm a medical asst and when we have a cutaneous biopsy or skin cancer excision, I anesthetize the area. One time a patient asked for a doctor to do the anesthetizing and I told her that I do this all the time. The dr, who's in the same room, told the patient to let me do it because I'm more gentle than him. I ended up giving the patient the injection.

 

Also, we had a new MD join our practice and some patients asked for the main Dr when she walked into their room. I remember her crying a few times when this happened because she said it made her feel incompetent. 3 years later, it doesn't bother her anymore and patients usually ask for her instead of the main Dr.

 

Moral of the story, it helps when you work for someone who believes/trusts in you. Don't take it personal when they ask to be seen by Dr. -- just give them some time to get comfortable with you.

[BeBe]

wow, i guess working in a mental hospital has thickened my skin more than i thought! ;)

 

these situations are minimally confrontational in my eyes, where it's not unusual for me to be cussed out and physically threatened by patients. however, if you're not used to someone being critical of your abilities, it's understandable to be upset.

 

in fact, when i first started working at this hospital, i was conducting drug rehab groups, and was just as qualified as all the other therapists. problem was, i was half their age. i had patients tell me they weren't going to do what someone young enough to be their daughter was telling them. and remember this is a situation where i'm trying to de-escalate an angry, psychotic person. my feelings were hurt at first, but i got over it quickly.

 

i've also had some ask me if i was even old enough to be working (bless their little pea-pickin hearts for thinking i look younger than 18!). LOL! i say, "i'm 25! how old do you think i need to be before i start working?" they usually laugh at themselves then....

 

i think considering patients like this as mental patients is good advice. because, honestly, they sound just like my precious ones here ( i LOVE my patients, and am very protective). you have to remember that firing back does nothing but escalate an already bad situation. you're adding fuel to the fire. you're job as a health provider is to "cause no harm". SMILE(kill them with kindness--it's a very satisfying type of revenge, believe me), let them have their way, and move on. you can't control someone else's emotions or reactions, but you can your own. like blocdoc, in my setting it's illegal to respond to a patient with a snide remark (verbal abuse). and from what it seems, you're really letting them take their medicine by having them wait, anyway. :D

 

so, basically, i look at it like, they can't really help themselves. assume that, and it will help. cause it's not your fault and certainly not a true reflection of your competency.

[Noreaster]

lakejl,

 

I do not think my ego has anything to do with it. Those, who know me, really like working with me, see me as a team-player, and maintain a poper humility.

 

If I were a patient and was told when making my appt. that I were seeing Dr. Smith only to find out that I was seeing a PA or NP, I too might be a bit disgruntled. I'm not in an ER but in an office, where appts. are confirmed with confirmatory phone calls the day before, etc...

 

In the situation I was mentioning, I wouldn't be so happy to make that patient wait an hour for the doc b/c it wasn't that patient's fault that she thought she was set up to see Dr. Doe. My point was that good set up with support staff / front desk help is huge.

[BeBe]

i totally agree. if they make an appointment to see the doctor and are not told they will be seeing the PA in advance, i can understand them being ticked off. i still like the kill'em with kindness approach, but they shouldn't have to wait because your staff screwed up.

 

however, when considering people that are coming into ED's/urgent care, you get all types.... and i still say kill'em with kindness. :D and if they have to wait, they have to wait. ;) as far as people with no social skills (like mental patients) you have to set boundaries with them. but sarchasm isn't usually helpful in doing this. you merely lose rapport.

[Guest lakejl]

noreaster,

 

I wasn't calling you an egomaniac, but it is human nature for the ego to be bruised with rejection. You have to admit that, in our profession, a slightly elevated self confidence (on the job) helps you to make decisions that affect the health of the patient, believe you are correct, and sleep at night. Of course, it can get out of control and be dangerous, but it is still vital in our profession. Still, you are correct about the support staff and whatnot.

[Noreaster]

Thanks for clarifying lakejl. It did sound a little bit like a slam. I have to admit that when I said that the support staff "have a healthy respect for me" that can potentially sound egotistical. The support staff also know me to be a team-player and I'm not above doing things myself if need be. It ends up being a healthy dynamic, of which I'm very appreciative.

[Guest guetzow]

Greetings All!

I usually say......."You will see the Doctor", then continue my Exam/SOAP as efficiently as possible(Such patients are like animals, they can smell fear, so falter not...). If, half way through the encounter, I am asked again, I quickly answer again(In a reassuring tone)"You will see the Doctor Today". Usually I finish the encounter, then go grab the Doc and tell him a patient wants to say hi. He goes in the exam room, chit chats a bit, repeats my plan to/in forn of the patient. Most patients get the idea: The PA and Doc generally agree on treatment plan, and the PA is an ok guy(End of issue for future visits....). If this first approach/scenario does it, then it's the usual agreeable pt/'what's a PA situation; easily delt with. If not, we have..."Scenario #2": After repeating "The Doctor will see you......Today", the patient says...."When". By now, you can usually tell if they are A)In a bad mood, B)Obstinant, C)Any combination of 'whatever'. In such situations(Scenario#2), I just tell the doc, "This particular patient would really rather see you", and he sees em'(We have a good working relationship, also important...). Again, end of issue. After that, just make sure that type of patient gets f/u with the Doc. We use Alteer software system that has SOAP Chart, Billing, And SCHEDULING on it. If I recognize a squirrely patient's name, I just switch em' over to the Docs schedule before they're ever brought back to the room. In a nutshell, tell the patient they will see the Doc after introducing yourself(If they ask, and it is an issue), proceed with your exam, 'then' get the doc to say hi for a few minutes. If the patient is a problem child, get the Doc to see em'.

P.S.-If you do not have a good enough working relationship with your Doc to deal with such patients, start looking elswhere. You, and your health are worth it....

[Banuchi]

...."I want to see and talk to the doctor only" she said. ....

 

I had the same exact situation happen to me. I don't remember what I said, but now I say, "No problem!" ...and I'd walk out....and of course I didn't forget to change their flag to show that their last to be seen....ouch! :p :D

[Marlene G]

LOL @ changing the flag.

The "real" doctor? I am not even "A" doctor. But I suppose it is their right. I like the idea of offices where patients are told, "Well, you can see the doc in about a month or you can see the PA within the week."

I honestly believe that much of the problem is that people either do not realize the personalized care a PA can give or they have the attitude that since they have insurance, they are entitled to see the "real" doctor. They think having to see a PA is some kind of an insurance conspiracy theory.

[Guest IrishPAC]

leahK,

 

I have been a PA for 5 years, you'll have to get used to this. Not many laypeople know what a PA is, and many healthcare professionals do not exactly know either. Hell, I have not figured it out yet either! If you do not think this is something you'll accept, get out of PA school while you can.

[Noreaster]

PA profession education: I worked at having the dude in charge of our website create links for the information page of the aapa site, which is cool. He actually created a few links... eg: so-and-so is a board-certified physician assistant and the link brings to the aapa info page. Also on the "links" page, a link is created called, "information about physician assistants." I also made up a one-pager' and leave a stack in the waiting room. I typed it myself; it's an eclectic collective info sheet from the usual sources. I've noticed that between 2 and 7 or 8 pages go daily. I also posted this sheet on the tack board in the staff break room for those, who aren’t sure about PAs.

 

I hope it helps at least somewhat; I can only think it does. I sustain being surrendered with the fact that people don't really know what we are/do, etc... and am still happy with this chosen profession.

[Tom Scoufalos]

Frankly, I don't want to see people who do not want to see me. There are plenty that do. I use RC's response in these situations too. I have been here longer than any resident in the place and the attending hasn't done one of these in years!

 

I went to a lecture at SHM last year. A lawyer/MD spoke. His job is to sue medical professionals for malpractice. He said the main reason a doc gets sued is due to failure to establish a positive relationship with the patient and to communicate with them. He said, if you just don't "hit it off" with a patient, don't see them anymore. Get someone else to do it. Remember, examining a patient who says they don't want to see you can be construed as assault and battery.

 

Personally in most cases, I do not take these things personal and consider them that person's problem. There are PLENTY of people who WANT to see us. I gladly turf those kinds of people to the doc. That's why they make the big bucks :D

 

Pat

 

I hear you. I very rarely have patients refuse to see me...I usually work on an appointment basis after all. About a year ago, I had some knob come in on a consultative visit, and proceed to give me the "I thought I was going to see a doc" baloney. "No problem" says I, "but you'll have to reschedule; we're all booked up today". He's okay with that, so I take him to checkout - no charge - and head back to document the encounter. The nurse calls back shortly afterwards; "The doc's appts are to far out; Mr. So-and-so said he's willing to see you now".

 

No dice.

 

The faith bond is already broken. All the more so as this guy had longstanding abdominal pain complaints, quite likely functional, and if you don't establish a very good rapport early on, NOTHING you do will ever be right or good enough, ever.

[jesscbv]

It sounds like the OP works with a cool Doc. As in any facet of health care, you're bound to run into the crazies who can't be bothered to reason or listen. But I think in general, when a patient is hesitant about seeing a PA it's not because they are rude; they just don't understand. I guess it's an opportunity to explain (politely and without snarky remarks) what a PA is/does. Ultimately it's up to the patient whether they'd like to see a PA versus MD. I don't think it should be taken personally. Heck, where I work some patients flatly refuse to see certain Docs based on gender, race, age, or even if they "just feel like that other Doc would be better."