Arbitrary

I've noticed that some of the patients we have are less than than trusting of the Physician Assistants at our office. They'll often question their diagnosis when they don't like what they hear, and will show up at the office two days later seeing the physician. Sometimes the PAs never know about this, but as a Faux-Murse I know all goings on in the office.

I can understand the patient's reasoning behind wanting to see the physician. The PAs are not the definitive care in the office, and are less experienced than the physician. But the interesting thing is when they see the physician they 99% of the time agree with the assessment of the PA, and that other 1% can be chalked up to style of treatment.

A funny thing to point out is that the PAs put a lot more work into their patients than the physicians. When presented with a wart the PA will pare (scrap) before using liquid nitrogen (freezing). When a patient comes in with a face filled with close comedones (white heads) the PA will do a much more thorough job cleaning them out. The reason for this - those procedures don't get reimbursement from insurance companies, but since the P.A. income doesn't depend on reimbursement they don't care about spending extra time with them. And in reality the physician shouldn't care about spending a little extra time with the patient because it ultimately doesn't affect the number of patients they're going to see. (PS - this is the main reason why I hate private practices, because patients become nothing but a symbol of income)

I've also realized from working in healthcare that physicians are by no means perfect. I think a lot of people get caught up in the title of "Doctor." They think there is something totally magical about the profession. I was talking to a friend of mine who's in medical school that I finally realized that medicine is not as complicated as it once seemed. I use to feel very leery of explaining conditions, medications and such to patients. But after a while I realized that the things I was telling patients was the exact same thing that the physician was. It's not rocket science all the time. Medicine is not a total science. In fact, it was quite a shock to me just how arbitrary medicine can be. This is especially highlighted when patients ask the simple question, "How did this happen." We don't know how you developed that abscess on your ass, or why you have terrible psoriasis, etc.

You know back in the day when I was applying to Osteopathic Medical (DO) schools I claimed that one of the reasons I prefer ed it over Allopathic Medical (MD) programs was because they treated the cause of the condition, as opposed to the symptoms of the condition. I feel like the majority of the work we do is just treating the symptoms, because we don't truly understand the cause of the disease. We throw a bunch creams at you until one of them clears up you skin. It often seems like total guess work. And actually, that's exactly what it is.

So what am I trying to some up in this multi-directional post? I guess I'm just sharing my reflections on just how abstract medicine can be. PA vs Physician? Protopic vs Ultravate? Allergic reaction vs Arthropod Assault (bug bites)? Honestly, sometimes it doesn't even matter. Medicine is not even close to the perfect science that some people think it is. Healthcare providers are very human. You know how at your job you generally know what you're doing, but often you still need to improvise. Well as scary as it is, medicine is the same way.