What it takes to be a great medical provider- besides just medical knowledge

[pennpac]

I am in a weird place in my life professionally and need some advice. I have been a PA for several years and haven't had the best luck with jobs. Some due to crappy management and/or unsupportive staff, others had to do with me ; I went to a good reputable PA program, and its hard to remember but I feel like they didn't teach us a whole lot on how to exude confidence with patients, how to talk to people, how to deal with difficult people etc. Even learning the physical exam, of course we practiced but each system was a quick "heres how you do it, practice on a classmate and move on" kinda thing. I did pretty well in school obviously but My clinical rotations could have been better, I feel like most of them weren't about teaching/showing and expected us to know everything and just threw me in to see patients for the most part. Either way it was years ago and since then I haven't had much training, just was thrown in to every job I have had. 

My spouse seems to think a large part of my problem is a confidence issue. I look a lot younger than I am and I feel like patients don't trust me, or don't trust PAs in general. When I examine family members like listen to their lungs if they have a cough they say it "feels different" than when their doctor does it, like I'm not being assertive enough, asking them to take deeper breaths etc. So it's really a combo of coming off confident to patients (even if I don't know something, making them feel like they're in good hands) and rusty clinical & physical exam skills. I don't know if there's a course on physical exam I could take to brush up, or watch youtube videos or what. I guess I am just looking for advice from experienced PAs on how to be more assertive with patients, be confident and improve me clinical skills so I can finally be a great PA. Unfortunately a residency wouldn't be financially possible right now.

Thank you!

 

 

Edited September 3, 2019 by pennpac

[sas5814]

Back when I was young enough and my back was good enough I used to ride horses a lot. I wasn't great at it and took a lot of advice from people more experienced than me. I remember being told a horse knows when you have no confidence in what you are doing...its a sense they have. Patients can be the same way.

I don't know how to help you exude confidence. That really comes from inside. I have had the other problem more....over confidence. That combined with being a pretty big guy with the basso profundo voice I tend to intimidate even when I don't mean to. 30 years in I think I have hit a better middle ground.

So from what you are describing I suspect the patients are sensing your trepidation. In this day and age of patient satisfaction surveys and Yelp reviews it is more likely you will have confrontational or even angry patients. They  will sense weakness and pounce like a hawk on a field mouse.

This sounds basic but how often do you practice being confident in the face of questions? Practice builds muscle memory so when the fear creeps in (or whatever word you use to describe it) things happen automatically. This was a critical skill in the military and during my time in law enforcement. I remember events unfolding and suddenly I am at an end point not having consciously taken any action but having done the right thing. Muscle memory.

I would recommend seeing a therapist to see where this is coming from. It is unlikely it is a sudden unexplainable feeling with no clear origin. I am sure it is something that can be improved. You just need the right guidance.

Best of luck

Edited September 3, 2019 by sas5814

[UGoLong]

I think I hear you, OP. One of the best features of being a PA (or probably many other "process-related" careers as well) is that our lives consist of individual interactions with patients. We can feel like crap from our last interaction and decide to do the next one differently. We can choose to exude more confidence, listen longer for a heart murmur, practice a long-forgotten neuro test, whatever. (We could even start speaking with an Australian accent, but I wouldn't recommend it.)

The point is, we have a great gift: we get to start over with each interaction. Especially the next one, right... now!

Your description sounds like you blame where you "are" right now on lots of things: crappy management, a poor PA program, looking younger than you are, etc etc. Personally I've found that kind of thinking not to be very helpful. Each of us is where we are for lots of reasons, some accidents of birth, some random interactions with others, and some personal choices. Regardless, dwelling on them as the cause of a problem often doesn't make us feel all that much better.

Personally, I've found it easier to remember that my thoughts -- especially those about myself and my performance-- are just thoughts; I give myself permission to change my focus and direction on a dime.  Using a football analogy (even though I've never actually played competitive football!), I just tell myself that my last "pass" was incomplete, it's now "second and ten yards to go", that it's time for me to stop ruminating about what just happened and "call my next play." I can choose, right here and right now, to do something differently or new. Like to move on and make the next patient interaction better than the last.

Or, to stick with sports analogies for just another minute: it's way more like football than it is like figure skating! I absolutely hate to watch figure skating. The commentator is always going off about this little tiny mistake or that one has absolutely ruined the contestant's performance and now the best they can do is a lowly X or Y. Not my view of life as a succession of personal adjustments.

While all of us can grow technically and polish up skills that we don't feel we are good enough at, the long game is often to cut ourselves some slack and just try again with the next interaction. And spend more time thinking about how you are bravely stepping out into the world and less time guessing what other people think about you (secret: they mostly aren't) or beating yourself up for things in the past that you can't change.

I wish you the best and hope that you can make something from the offered advice that makes life better for you moving forward.

Edited September 3, 2019 by UGoLong

[thinkertdm]

I am personally a very shy and introverted fellow.  One would say this is not the occupation for me.  However, you don't need to be sociable; this isn't a club or radio station.  In fact, what I do is just before I go to work, is get into character.  It's a show, after all.  Like any good actor, its more than just going through the lines like Edward Norton in most of his movies; each and every movie, that's Edward Norton.  

However, think about John Malkovitch, or Dustin Hoffman.  Some roles, you are astounded. 

So, take the role.  Own it.  It will take a bit of practice.   

[ohiovolffemtp]

One of the most important things in dealing with patients is sincerity.  Once you learn to fake that, you've got it made.

I mean this only partially tongue in cheek.  Here are some techniques I use:

- I acknowledge their worries and try to calibrate them by saying which s/s are probably not concerning, which ones might be, and which if any are.

- I share my thought processes with the patients, family, and staff by talking through them out loud while in the room: "we're going to do X testing, Y imaging, and Z initial meds for S/S management."  That gets everyone on the same page, and implicitly shows that I have a plan, including contingencies.

- As I do my H&P I share the significance of what I'm seeing, feeling, and hearing: helps the patient know how things look, and also implicitly shows them that there's a thought process running.

- I set expectations about what we'll rule in, rule out, and leave unanswered.  I do EM, so an answer of the form that we're not sure of the diagnosis, but it's not immediately critical and further workup in the outpatient setting is sufficient.

Tone of voice is very helpful.  Think of what tone you'd use to console a scared 4 year old - use that with patients.
 

[rev ronin]

Why are you a PA?  Why are you in your current job?  If you're lacking a connection between your current task and your raison d'etre, you're going to suck.  So...

1) Articulate your life goal.  If you can't state it in one sentence, you don't have one.  If you don't have one, you can't succeed at it.

2) Evaluate it.  Is it right? Do you still believe it? Does it resonate with your core spiritual or religious beliefs?  Do you want it on your tombstone? Refine it if needed, scrap it and start over if you must,  do some soul searching if dissatisfied.

3) Figure out what you need to do, in your current job or elsewhere, to achieve your life goal.  If your job is only to pay the bills... fine.  Not great, but fine: sometimes, we just pay the bills. However, in what ways are you going to take one step closer to your life goal?

Once you've gotten a conceptual framework down, the skills you need to achieve it will be much more clearly in focus.

[EMEDPA]

keep showing up every day and honing your craft. it gets easier when you see the patterns over time and can make dx from the doorway more often than not. 

[surgblumm]

A. Listen to your wife as she knows you better than anyone else.

B. Listen to the guy in the mirror. would you want him to deliver your healthcare.

C. Grow a mustache , it make you look five years older.

D. Listen to the comments of SAS and RevRonin, they wer tailor made for you.

E. Decide what you are going to do as far as a career move or get off the horse and try a similar field.

F. Write your old school and mention this deficiet in their teaching.

G. I would also see the psychologist as you are too invested in your profession to let it die on the branch because you lack confidence.

 

[cinntsp]

On 9/7/2019 at 6:59 AM, surgblumm said:

C. Grow a mustache , it make you look five years older.

 

lol Bob...too true.  Go with a beard, though.  A mustache by itself is only good for 1800s cowboys and serial killers.

[cinntsp]

On 9/3/2019 at 7:09 AM, pennpac said:

I am in a weird place in my life professionally and need some advice. I have been a PA for several years and haven't had the best luck with jobs. Some due to crappy management and/or unsupportive staff, others had to do with me ; I went to a good reputable PA program, and its hard to remember but I feel like they didn't teach us a whole lot on how to exude confidence with patients, how to talk to people, how to deal with difficult people etc. Even learning the physical exam, of course we practiced but each system was a quick "heres how you do it, practice on a classmate and move on" kinda thing. I did pretty well in school obviously but My clinical rotations could have been better, I feel like most of them weren't about teaching/showing and expected us to know everything and just threw me in to see patients for the most part. Either way it was years ago and since then I haven't had much training, just was thrown in to every job I have had. 

My spouse seems to think a large part of my problem is a confidence issue. I look a lot younger than I am and I feel like patients don't trust me, or don't trust PAs in general. When I examine family members like listen to their lungs if they have a cough they say it "feels different" than when their doctor does it, like I'm not being assertive enough, asking them to take deeper breaths etc. So it's really a combo of coming off confident to patients (even if I don't know something, making them feel like they're in good hands) and rusty clinical & physical exam skills. I don't know if there's a course on physical exam I could take to brush up, or watch youtube videos or what. I guess I am just looking for advice from experienced PAs on how to be more assertive with patients, be confident and improve me clinical skills so I can finally be a great PA. Unfortunately a residency wouldn't be financially possible right now.

Thank you!

 

 

You come across to me as someone with anxiety d/o.  I would highly recommend seeing a psychiatrist/psychologist that practices CBT.  It could be a game changer for you.  

[d-wade]

On 9/7/2019 at 8:59 AM, surgblumm said:

A. Listen to your wife as she knows you better than anyone else.

B. Listen to the guy in the mirror. would you want him to deliver your healthcare.

C. Grow a mustache , it make you look five years older.

D. Listen to the comments of SAS and RevRonin, they wer tailor made for you.

E. Decide what you are going to do as far as a career move or get off the horse and try a similar field.

F. Write your old school and mention this deficiet in their teaching.

G. I would also see the psychologist as you are too invested in your profession to let it die on the branch because you lack confidence.

 

This is why I have the beard, and 'decided' to lose my hair.