Thursday, November 17, 2016

ARDS and Prone Positioning: A Review of the Literature

click on this link to view pdf
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Wednesday, November 16, 2016

Bridging The Gap: PA's in Critical Care

Since its inception, PA’s have been bridging the gap in healthcare. In fact, the role of the PA is to expand and increase access to care for those who otherwise might not get seen in a timely manner, or not seen at all.  After all, that was the basis for implementing PA’s fifty years ago. This is most true in underserved area’s like small counties where PA’s have always filled the gap, but the gap is also being filled in an area that very much interests me; critical care.

One of the many things that attract me to the field of PA medicine is the diverse field of medicine in which PA’s can see and treat patients, while still being supervised by a physician. In other words, I like the diversity PA’s enjoy. Since I have worked as a respiratory therapist for the last two decades, primarily in adult critical care, I feel pretty strongly that that’s where I’ll end up once I become a PA. I realize I need to keep an open mind as I begin the PA program this coming Fall, but in the end, it is critical care that I am really gravitating towards.
Since I have a predilection for the intensity, challenge, and diversity that critical care offers (along with familiarity), I’ve often wondered how MD’s view PA’s (and other advanced practice providers) as they pertain to critical care. I have especially wondered about MD’s in training, which may have to compete or share with PA’s for procedures. I currently work at an academic medical center and know that jockeying for procedures can create conflict amongst those on a team. However, many ICU’s have incorporated teaching teams and non-teaching teams in the ICU. The separation of these teams within a particular ICU seems to have made great inroads at reducing such conflict.
Another issue that is present in the academic ICU, is a gap in physician coverage that has been created with the implementation of work-hour restrictions. The Accreditation Council for Graduate Medical Education (AGGME) implemented these restrictions in 2003. With the imposed work-hour restrictions, there has been a real gap placed on workflow and manpower in labor-intensive areas of care, like what is standard in the ICU setting. With this gap, PA’s have been able to successfully fill the void. But…how are PA’s being perceived in this setting?

According to the first article listed below, advanced practice providers (APP’s) are viewed by most residents as either having a “positive” impact or a neutral impact on their overall ICU experience. As a person that is looking to work in an ICU setting after PA school, and possibly at an academic center, it is nice to know that PA’s and NP’s are viewed in this manner. So, for someone like me who is seriously contemplating a career as a PA working in the ICU, knowing that this is a place I can successfully hang my hat is nothing short of exhilarating and exciting to contemplate.

Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents' critical care experience
Kahn SA, Davis SA, Banes CT, Dennis BM, May AK, Gunter OD.
J Surg Res. 2015 Nov;199(1):7-12. doi: 10.1016/j.jss.2015.05.036.
PMID: 26173380

Commentary on: Impact of Advanced Practice Providers (Nurse Practitioners and Physician Assistants) on Surgical Residents' Critical Care Experience
Tsai PI. J Surg Res. 2015 Nov;199(1):13-4. doi: 10.1016/j.jss.2015.08.033. No abstract available.

PMID: 26456354

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Thursday, September 22, 2016

Why do you want to be a Physician Assistant?

                                                   
The other day, a co-worker asked me why I wanted to be a PA. Sometimes when you get asked questions of the personal nature, off the cuff and unexpectedly like this, we tend to stumble and try to come up with a reasonable and satisfying answer. For me, this one was easy to answer.

I’ve been a respiratory therapist for 19 years now. When I had reached the five-year mark in my career, I started to realize several things about myself that I would have never believed from anyone, had tried to tell me. One of the most important things that I was beginning to learn about myself was that I really loved being a respiratory therapist and all that it brought me in terms of personal satisfaction and job satisfaction. I was working at a hospital in Georgia where the respiratory therapists had a great deal of autonomy and nurse/physician respect. The respiratory department I worked in was very progressive and the RT’s there did patient assessments that allowed us to order and tailor a patient’s therapy to their needs, within certain guidelines. We got to intubate patients in the ER, ICU’s, and during code situations. In short, we had a great deal of autonomy and had a wide birth when it came to ventilator management. But the only things was, as much as I enjoyed this autonomy, I really began to crave more as time progressed and as I gained experience in the critical care setting.


Another thing I began to notice, right about that five-year mark, were these people that worked in the ER with the doctors. They weren’t doctors, but you couldn’t tell unless you specifically looked at their credentials on their lab coats. These bedside clinicians carried themselves and even seemed to function much like that of a doctor, were actually physician assistants (PA’s). Wow!!! Was I ever impressed with their demeanor, professionalism, and clinical expertise? These guys and gals seemed to me to be a lot like doctors and I realized I needed to find out more about them, their training, and if it was even a possibility for me some day.

As it turns out, during a night shift when I was working, I got the opportunity to talk to one of the PA’s that had caught up on seeing all the patients he had in the ER and had a little down time. I learned a lot about the profession and what PA’s got to do. I learned that they had the autonomy that was lacking in the respiratory field and sounded an awful like the autonomy I was seeking. I also learned that PA’s are trained on the medical model, and with this type of training, you’d be able to work in area’s and do things that our counterparts in nursing, Nurse Practitioners, couldn’t do. For me this special field quickly became very appealing and something I one day wanted to be a part of. 


                         
It was at this point in my career that I began to really understand just how much I enjoyed working with patients and interacting with them and their families. I can’t explain it in the words that would sufficiently describe it, but I just really enjoy being at the bedside with patients. I have been extremely fortunate over the years, in that, I have had some very special and memorable patient interactions that have left me simply wanting more. They say once medicine truly gets in your blood, you can never quiet be satisfied. I firmly believe this and I think it is that drive and desire to do more, be more, and bring more to our patients, is what truly embodies the PA profession. And that, my friends, is why I want to be a PA.

To me, being a PA will afford me the autonomy that the field of respiratory care simply can’t give at this point in time. Being a PA is something that is realistically within my grasp; once accepted to a program, the typical training is 27 months. As a PA, I will get the privilege and opportunity to get much of the same training that a physician will receive, but without the significant time and financial commitment that comes with going to medical school. In fact, many of the places where I’ll do some of my clinical rotations, I’ll be alongside medical students, interns, and residents.  So for me, becoming a PA has been the obvious next step, when it comes to my love for the science and art of medicine, where I get to help and interact with others, whole being allowed to have the autonomy to use my training and critical thinking skills.

Do you know why you want to be a PA?
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Thursday, September 15, 2016

Gross Anatomy: Bryan's awesome links, books, and websites

One of the introductory, fundamental courses that PA students take in their very first semester of PA School is Gross Anatomy. Gross Anatomy can be a daunting course, very time consuming, and quiet possibly one of the most challenging subjects a new PA student faces. Or, at least that's how I felt when I was in PA School. When I return in the Fall of 2017, I'm sure Gross Anatomy, along with Medical Physiology, will be the two courses that will require the majority of my time and energy, if for no other reason, because of the sheer volume of material that each course covers of the short time allotted. It's truly like drinking from a fire hydrant; Trust me!

During the time I have between now and when I start back in the PA program, I have been working hard to prepare myself for the storm that is promised to come. Knowing the challenges that gross anatomy can pose, I have spent a significant amount of time locating books, websites, and videos that I have found to be helpful. As such, I would like to share them with you, the reader.

I hope you'll find these helpful!


Textbooks:


Flash Cards:




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Monday, August 8, 2016

Medicine: The Ultimate Team Sport

I have the great fortune of working in one of the top University Hospital’s in the nation.  Everyday I work alongside medical students, interns, residents, fellows, attending physicians, Pharm D’s, and other medical professionals. After being in medicine for 20 years now, and for the first time in my career, getting to work in academic medicine, I can now see just what a team sport medicine really is. Academic medicine, unlike that seen in a community hospital, is truly a massive team of individuals working toward a common goal; to take the care of the patient and offer the latest and greatest that cutting edge medicine has to offer, from some of the brightest minds.

In the past, I had mistakenly assumed that the guys and gals in the white coats, were all knowing. In fact, I thought knowing all the answers to all of the questions was required for the job. After being in academic medicine now for roughly five months, nothing could be farther from the truth. I see everybody on the team get stumped or not know the answers to the question of the hour or what medicine is best, or what the normal value might for a particular parameter. Because medicine is such a broad, comprehensive science, it’s just impossible to know everything. It’s ok not to know; it’s just not ok to not seek the answer or keep learning. That’s what makes medicine the ultimate team sport!!
 
In my opinion, you must have the humility needed to seek help for your teammates. Chances are, your weakness my be their strength, and vice versa. I see it everyday! I see very smart, well educated, highly talented doctors and doctors in training, seek help from others on the team. There is no shame in one’s game for asking to have another team member to lend their expertise in the fight for victory. This is especially true when shouldering the ultimate responsibility of caring for a fellow human being. That’s what, in my opinion, takes a good team and makes them great. We’re all trying to move the ball down the field and score one for the patients that have entrusted us with their care, and often times, their lives.

Medicine; the ultimate team sport!
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