In which a PA makes a patient feel seen and creates work but doesn’t necessarily do anything useful medically.
I had my first encounter with a physician assistant on Friday.
Actually, I lie. Back in 2001 I was treated by a physician’s assistant in Madison, Wisconsin in the US when I contracted a Mycoplasma pneumoniae infection the day before I was due to fly home.
That cost me a small fortune for a packet of antibiotics but was otherwise unremarkable.
Last Friday, I had the dubious pleasure of being stuck in ED with my poor old mum who had had a fall and was awaiting an x-ray to check her hips. (Truthfully, we weren’t in ED at all. We were in the ramping bay, along with eight other patients, 14 paramedics, three doctors staring at screens, no nurses, my mum and me. But that’s a whole other article.)
My mum has dementia and after a couple of hours was beginning to get very agitated, which in this case was vaguely beneficial because it facilitated getting her some care before a bed in the ED came up.
Someone who, I admit, I assumed was a nurse, approached and started asking the right questions and explained that he could get some processes started – putting in a cannula, ordering x-rays and – once he’d taken a look at her file – a CT head scan.
“She’s on apixoban and she’s had an unwitnessed fall,” he said. “I have to go by the protocols and therefore I have to order a CT head scan.”
No worries, I said, just grateful that we were jumping the queue somewhat.
While he was putting in a cannula and drawing some blood for tests to make sure Mum didn’t have an infection, we chatted and it turned out Dave was a PA – one of the first in the country, according to him. He’d spent 20 years as a paramedic, before doing his PA training in the US.
Another hour puttered by with no further input from Dave, or anyone else, until a young emergency doctor turned up to do a pretty thorough exam of Mum.
“Let’s just get an x-ray,” she said. And off we went.
The good news is, no fresh fractures for Mum, but before she was discharged the emergency doctor came to me and said, “Look, your Mum’s 85, she has severe dementia, she’s not showing any signs of a head injury, and besides even if she was, there’s an order for no invasive procedures for her, and nobody in neurology would want to operate on her anyway. Do you mind if we cancel the bloods and the CT head scan?”
Nope, I said.
Now, the PA, bless him, knew all of those things because it’s all in Mum’s file, and we discussed it. But he was obliged by the protocols to do the blood tests and order the CT scan.
So in the end, my mother had a cannula put in that she didn’t need and yelled blue murder about. And the imaging department had to find room for her, and then got a cancellation.
This is one of the difficulties that PAs face if they want to increase their scope of practice.
A younger emergency doctor, with more training but less experience, could – rightly, in my opinion – override the PA’s calls, saving time and money for both my mother, and for the hospital.
Was it all a waste of the PA’s time? Probably. Did it make things better for the patient? Not in the end. Did it make me feel better as a carer wanting to get my Mum through the system a bit faster? Yes, but in the end it was the doctor’s decisions that got things moving.
Did he do anything a nurse couldn’t? No, except he was able to initiate things off his own bat, and more importantly, he was the one who was available to do something. Every nurse in the joint was otherwise occupied beyond the ramping zone.
It’s an interesting dilemma and I feel for Dave and his colleagues who are trying to get the most out of their training and career hopes. I’m just not sure they are the answer to getting our public hospital emergency departments flowing more freely.
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