Most of this morning’s patients were follow-up patients. Two were acute add-ons. Many of the patients see her regularly, but at least one was seeing her because she was the first provider available.

I knew the PA from previous working experience, so we were able to dispense with the introductions and get right to the job at hand. The first thing she showed me was the electronic medical record (EMR) upon which she had two charts open for patients she had seen the previous day. She reminded me that, though the patient leaves the office with his/her plan of care, the documentation isn’t finished quite as quickly. Some of the documentation is done in the room while talking to the patient, at least enough to remind you when you sit down to finish the chart later. The rest of the documentation is often done during lunch, after the last patient of the day, or the next morning.

She told me that a provider trains his/her mind to remember what happened in the visit when it is time to finish documentation.

She had her schedule printed out before the day began and gave it a cursory glance to see what the day’s patients were coming in for. She could then look up past visits, if necessary, to remind her of the patient’s history and where she had left off with them. For the most part, when she entered the room with the patient, she was able to let the patient know that she remembered the last visit and what direction they were heading in.

I noticed that the patients really trusted the PA and wanted to know her opinions about everything related to their healthcare. One patient was schedule to see two MD specialists, but wanted to come back and see the PA to get her opinion on the matter before following the specialists’ advice. Another patient kept expressing her anxiety and stress due to her work situation. This patient seemed to want to talk about that a little more than she was able to during the office visit. The advice of the PA was important to both of these patients.

A 16 year old patient came in with a rash that her mother thought may be an allergic reaction to antibiotics she was taking. As the facts were investigated, it was found that the patient had been on the same antibiotic relatively recently with no side effects, plus the rash didn’t fit the typical allergic skin reaction pattern. She had, however, been swimming multiple days in the row, reusing the same damp swimsuit. In the end, the PA didn’t unnecessarily diagnose the patient with an allergy to a medication she may need in the future when there wasn’t conclusive evidence to do so.

Another of the acute patients was someone that I thought could have been treated over the phone if the PA had known the extent of the problems at the time. The patient had been seen for a similar problem in the past, had somewhat of a history actually. The patient had all the medications prescribed to her earlier in the year for a skin irritation but hadn’t needed to use the entire prescription. The patient didn’t have a new problem or need a new treatment plan, but just needed confirmation from a provider that it was OK to use the medication for what seemed to her to be a different incident. The PA was able to recognize the symptoms from earlier visits and recognize the medications from the EMR and assure the patient that it was appropriate to use them.

The last patient of the day told me she liked the PA because the PA was thorough. Right away, the PA started asking questions that didn’t seem to have to do with the chief complaints at hand. Through further probing, it was found that the chest discomfort and weakness the 38 year old patient was feeling was probably due to a new onset of hyperthyroid rather than any kind of cardiac problem, which she had been worried about. That patient had been good natured and making jokes, but deep down she was worried that her unhealthy lifestyle might be catching up to her. The PA was able to calm the fears significantly before the patient left.

I noticed that for every medical decision the PA made, there was another consideration that had to be followed up. For instance, when prescribing one medication to a patient, the PA then had to make sure to follow up with blood work afterward to check the liver. She also had to follow up with the prescription to make sure it didn’t cause a cough, which is the most common side-effect. No medical decision is an island. Medicine is an interconnected discipline and has to be practiced in that manner. That is often a challenge for an urgent care or emergency facility treating a patient they don’t know. The patient can be on other medications, have other allergies, and have other diagnoses that are going to affect medical decision making, however the provider doesn’t always have access to this information. In this regard, family medicine can be a little harder – you have to keep up with the patient’s entire medical history – but also a little easier because you have the medical history available when making decisions.

I realized a couple things from the experience I had today that I hadn’t thought of before. First, family medicine gives you a wide range of patient care opportunities. I like the thought of a challenge, as in the situations that present in an emergency department when someone’s life has to be saved and you might not know that much about the life before having to save it. Family medicine hints at this challenge with acute visits in a multi-provider practice. A patient you are unfamiliar with comes in to be seen for a problem you haven’t been following.

On the other hand, I like the thought of following up with the patient and seeing where my medical decisions brought them. Is the patient better off in the long run because of how I handled his/her care? Am I able to make the slight alterations in the care plan in each successive visit that ultimately lead to a healthy, enjoyable life for my patient?

Secondly, I was told that a provider trains his/her mind to remember what happened in the visit when it is time to finish documentation. I believe I would have the ability to see a patient at one point and document the visit later if necessary. Even now, hours after I have left the office, I can remember what the patients were seen for and how the PA treated them. Beyond the chief complaint and main reason for the visit, I remember many of the secondary diagnoses and other medications the patients were on that we saw today.

There were also some things from my shadowing experience today that I have further questions about. First, I understand the wisdom of looking at the schedule to know what to expect during your workday, however I wonder about planning the encounter before entering the room and the prejudices that come with it. From what I experienced the facts the patient gives, as they give them, influence the provider, but assumptions the provider researches before the visit can influence medical decision making before even talking to the patient. The patterns we see in healthcare can become ruts if we think that every patient with problem X can be treated the same or every patient with insurance Y abuses the system. It seems like it might be wise to mentally prepare oneself but be open-minded enough to not miss anything out of the ordinary.

Also, I think it is important for a PA, or any practitioner, to know the EMR well enough to be able to glean all the useful information from it. Healthcare may have been around a lot longer than the computer, but the computer can help in so many ways…if you know how to use it. Knowing how to access all the documents you want, and need, is key.

Lastly I’m concerned that some of the repetitiveness of the job might cause a provider to not fully listen to everything the patient is saying…and suggesting. I’d like to think that a PA is following up with a patient’s explicit and implicit anxieties instead of just focusing on prescribing a medication. There is an enormous link between a person’s mental well being and his/her physical well being, and that link works in both directions. If one is down, it can bring the other down. If one is up, it can bolster the other. Hopefully the practitioners of medicine aren’t just skimming the words coming out of the patient’s mouth for key terms and phrases, but are truly listening and taking into account everything the patient communicates to them. From just one morning in a family medicine office, one morning of listening to patients talking to a PA, I believe in a holistic approach to practicing medicine. This entire body of ours is inter-connected and it seems like it should be treated appropriately.

Requirement: Anatomy and Physiology needs to be 8 credits taken within the last 7 years. The anatomy I took was Comparative Anatomy in the fall of 1996. I needed to get a B or better, and I got a C+.

Plan: I am signed up for A&P I (4 credits) this coming semester. I will get an A. I will take A&P II (4 credits) next semester and also get an A.

Requirement: 250 hours of direct patient care (CNA, CMA, EMT, RN, etc.). I have zero hours of direct patient care, though many years of working in healthcare.

Plan: I am signed up for an EMT course. I will pass with a high grade and start working as an EMT. This line of work actually interests me and is not just something to pad my resume, so that helps. Incidentally, this class requires an up-to-date Basic Life Support (BLS) certification. I have signed up for the course on the 25th.

Requirement: My Biology-Chemistry-Physics (BCP) average needs to be over 3.0, with more competitive applications being closer to 3.2 or 3.5. Mine is currently a 2.75 (and that’s what you get for slacking off in college, my supposedly smart friends).

Plan: An A in both A&P semesters will bring this BCP average to a 2.9. I need to get an A in another BCP class next semester. If that’s not enough, I may need a summer class in the May term (a human-related biology was suggested…I have lots of animal classes). If 8 credits worth of A’s brings me to 2.9, another 8 credits worth should bring me to 3.05.

Strongly Required: Shadowing a PA to know exactly what a PA’s roles and responsibilities are. Now, I have worked with Pas for 9 years now but have never officially shadowed one.

Plan: I want to shadow as many PAs as possible between now and my next application. My employer has a shadowing program. I just need the approval of a department head to shadow within their department. I have sent off some emails and I already have one PA willing to let me shadow him. I plan on typing up a paragraph or two of each experience after I have done it.

Other Suggestions:

Work on my essay for the application. Let them know why I’d be a good choice.

Come to the spring open house. Meet the staff. Make myself known.

Explain in more depth on the application exactly what my healthcare experience is. I guess I was rather Spartan on the info, figuring they’d ask more, in-depth questions at the interview. Ooops. I didn’t get an interview.

I also feel I should look up the requirements of a few other PA schools around and make sure I meet their specific prerequisites. I can’t put all my hopes in one school; it has burned me twice (by my own fault, yes).

So, I have a plan and I’ve gotten right on top of signing up for things. Let’s see how it goes.

Let me say, I am 3 books behind at the end of July, but that’s not why I’m stopping. I fully believe I could catch up those three books, though I do tend to read long books. I’m stopping the goal due to the fact I have just signed up for 9 credit hours of classes next semester.

My knowledge is rusty, and I’m really going to need to read up on my subjects. As a matter of fact, I’m starting rather soon. I pulled out my BLS for Healthcare Professionals books yesterday so I could start reviewing. BLS is a prerequisite for my Basic EMS course starting in September. I have a feeling I’ll also need to review my first aid hand book that I also pulled out yesterday.

My other class is A&P. I’ll begin looking over my wife’s book as soon as I get the course syllabus. That and I’ll use A&P wallpaper on my computer to help study.

I won’t be giving up on reading; I’ll just be slowing the pace. It is healthy to know when to stop trying for your goals because of a life-changing event. It should be an interesting remainder of the year.

We looked over the menu thinking there had to be something that would be the slightest bit appetizing. Well, there was: some kind of spinach and soy cheese wanton. However, that was an appetizer, and my wife seemed loathe to let me order only an appetizer and not a main dish. I might add a couple things at this point: 1) I am very good at choosing only a simple appetizer and enjoying it at a place where the menu seems a bit suspect to my tastes. One time I ordered only a bowl of clam chowder, and enjoyed it, while the rest of my dining party was nauseated with their dinner selections. I spent less money and had a better dinner. I trust me. This did not happen last night. 2) There was another person at the dinner last night, much smarter than I was allowed to be, who was allowed to not order anything at all. Nothing. He didn’t order only an appetizer. He ordered nothing. And he got away with it. I don’t know exactly how the birthday girl thought of him, but I didn’t hear anyone coming down on him for not ordering. Taking those two facts together, I should have just gotten an appetizer.

My steamed vegetables came to me covered in peanut sauce. I thought it would be pretty good and all I would have to do is pick out a few of my least favorite vegetables. Unfortunately, the peanut sauce was chunky not smooth. Also unfortunately, as of late my body has had a bit of a problem with chunky peanut sauce.

A couple weeks ago I was, what one would call, violently ill. The last thing I had eaten earlier in the day we some roasted peanuts. The taste of roasted peanuts stayed with me through the entire day as my stomach ached and caused the most nauseated feelings I have had in a decade or two. These feelings culminated in a grand, if not violent, outpouring of nothing other than chunky peanut sauce a few times that night. Flash forward that picture to the chunky peanut sauce I was staring at on my plate last night. I should have just gotten an appetizer.

We headed back toward home from the interestingly busy vegetarian restaurant and decided to stop at a Dairy Queen at the halfway point. The DQ in Augusta is a small little hole in the wall with no inside seating, though it does have inside serving. The pictures of the 25th anniversary Blizzards were deliciously tempting. I ordered a medium Tagalong Blizzard to make up for my dinner. The Blizzard looked great; the kid had even sprinkled some of the Tagalongs on top when he was done mixing it up.

The first few bites were not too bad. I was just enjoying the ice cream, a delicacy I don’t indulge in quite so much these days. After the first bites, I noticed the Blizzard was awfully soft. It was as if the ice cream was melting rapidly or maybe it wasn’t too hard to begin with. It also started tasting funny, and not a good kind of funny like a clown. It was definitely the bad kind of funny, like nauseating chunky peanuts.

I finished almost the entire Blizzard (hey, I paid for it), and drove home quite disappointed all in all.

Today I had a Mint Oreo Blizzard for lunch. It was awesome. The end.

Once we had made it underneath the overcast sky, Dallas spread out before us as far as the eye could see. It was dark out, so what I actually saw was lights. The ground was flat, and out my window lights spread all the way to the horizon. Looking across the aisle and out the other window, I saw the same sight. Dallas was huge.

From the airport we rode a bus to the rental car station. I am used to rental car stations being located inside the airport. This trip was 10 – 15 min of nonstop travel away from the airport. The rental station alone was a large building full of unused space.

I could get used to the great wide open.

I hope it’s not just me and him playing chess against each other…

May: $138.55
June: $211.21
July: $240.49
Aug: $265.03 (so far!)

I’m going to need a grant soon to be able to keep up my family friendly ways. Either that or go back to being a hermit.

Verbal Score: 670, % Below: 95

Quantitative Score: 700, % Below: 71

Analytical Writing Score: 4.5, % Below: 63

I guess I shouldn’t complain since the test went over a lot of information I knew back in high school but had long since forgotten. And I only spend a couple weeks before hand, here and there, refreshing myself. It’s the story of my life. I did OK, but could have done better if I’d practiced more.

We’ll see where this all leads me, if anywhere.