Wednesday, December 31, 2008

Point and Counter Point

Anji left an interesting comment following my last post. For clarity, I'm reproducing it here, so as to offer my take.
I guess... as a patient and having experienced something say, a yeast infection or a urinary tract infection or a sore throat needing to be looked at, and getting the ol' "you're-wasting-my-time" look from the doc, I'd rather go to a PA while my doc goes and tackles something else much more challenging.

Or, at the very least... make my doc stop rolling his eyes when I haven't been able to swallow for two weeks and my glands are huge and I just want some antibiotics or some relief! :D

My husband is a medic with the canadian army and I'm encouraging him to go for his PA as soon as he is able to. He's too old (36) to start fresh and become a doctor but he's not too old to do the PA and still earn a living in his second career. We're so short of doctors here, anyone who can alleviate the pressure or at least, free up enough time so doctors can provide more care for serious things, would be nice. Something like, 10 million Canadians (out of 30 million in total) do not have a family physician. PAs would
really make an impact, in an area like ours with such shortages!

Personally, I think that, as Doctors, we should be happy looking at yeast infections/sore throats/UTIs. Generally, they don't need to be seen in the ED, that's true, and patients pitching up to the ED may occasion the rolling of eyes... BUT: if the system doesn'tprovide another opportunity for patients to see a Physician, then it's not their fault, and we should keep our eye-rolling to ourselves. That should be part of the deal: you can come to us with anything and not feel ridiculed. We should be allowed to roll our eyes BEHIND CLOSED DOORS. And I'm more than happy for PAs to see this stuff; but if their breadth of experience extends only to simple sore throats are they more likely to miss early meningitis? to mistake glandular fever for tonsillitis?

The point I'm trying to make, and labouring rather, is that Doctors have, or shoukd have, a breadth of experience, born of experience. And what at first glance appears simple and straight-forward may not be. I would argue that that is when we earn our pay - not in the vast bulk of practice, which is routine (and often gets better no matter what we do... sore throats are an excellent example of this, despite the public love of, and faith in, antibiotics), but in the recognition of, and prompt treatment of the more serious cases.

I reckon I could take one of my more dextrous, non-medical friends and teach him how to take an appendix out; but not what to do when things went wrong, or when the diagnosis doesn't match the operative findings. Being an expert in a very small area will mostly be fine. Mostly.

Do we need more practitioners? Yes.

But I'm not convinced that telling ourselves that, as doctors, we don't need to be dealing with certain conditions is the answer. Maybe, economically, it makes more sense to employ PAs, and if practitioners want to perform this sort of extended role - brilliant. But, like most solutions for thorny problems, I'm not convinced it's perfect.


anji said...

It wasn't actually in the ER that he rolled the eyes... but in his clinic/office. It's happened to my mom as well... often in our northern community, where over half of the population doesn't have a family physican, we have to. For example, we've been posted two hours away from where I lived 20 years. I still drive the 2 hrs up to see the doc when I need it, and then drive home. Something more seriously, I head to the local ER ... they are understanding in knowing that and I haven't had any problems with eye-rolling here. In fact, I usually feel stupid having to go but they've reassured me, being an area short of doctors and military wives and kids needing help, they'll do it.

I understand a lot of things can get missed dring what apepars to be a routine sore throat needing antibiotics that a PA can potentially miss. But, I think if a clinic was properly run... nurses doing nurse stuff, PAs doing PA stuff and docs going over doc stuff... I think there would be room for the PAs to go to the docs if they suspect a problem require further diagnosis... or, vice versa -- a doctor knowing what the PA is see, could check up on the patient too... it's everyone's responsibility for that patient from the time they enter that place, right?

I don't know. Perhaps I am an idealist! And, yea -- you're right -- the eye rolling can be done behind closed-doors which most of us are pretty sure docs/nurses do anyways....

I got to do my share of eye-rolling when my doctor's wife came into the retail store I worked at during college, bought $1500 in back-to-school supplies for their seven children... acted snottily at me... and then, her husband made them return it almost all the next day because he didn't approve of her spending habits.


Hope you didn't think I was butting in on the subject but PAs are just becoming "a thing" accepted here, as well as nurse practioners. So, it's still very new for us (the patients) and them (the nursing and doctor staff). Give it ten years and see if it catches on here!

scalpel said...

Very well said.

DrShroom said...

Butting in always welcome; this is a broad church.
There is, of course an issue with responsibility, but I worry we may be giving too much responsibility; the sins of ignorance and incompetance are very different, but produce the same outcome.
And I'm still nervous about 'dismissing' some aspects of medical practice as "PA stuff". As physicians, we should be proud to own all of medicine, even the bits we don't like...