Monthly Archives: October 2016

Breaking Down PA School Interview Questions XI

Focus on social media and internet self diagnosis!

Q: Would you accept a Facebook friend request from a patient?

What are they looking for?

  • Understanding of ethics and patient interaction
  • HIPPA
  • Professionalism.  My program was HUGE on this, it was a percentage of every class grade. 

What to avoid saying

  • “Sure, I have drinks every friday with patients from the clinic I volunteer at”
  • “Yes” without any thought consideration.
  • In my opinion saying “yes” at all.

What to say

  • The best and most effective patient-provider relationships are those that do not encompass dual relationships
  • Even with clear cut “simple issues” such as a UTI, you can never predict what issues may develop with a patient or a family. 

How you might be pressed 

  • What about in a small town where everyone knows everyone?
    • The good thing about being a PA is that there is likely a collaborating MD/DO who shares time in the clinic.  
    • State that you understand that you may know a number of your patients from other community groups (gym, church, etc) and that as frequently as humanly possible you would have patients with whom you have close personal relationships see your supervising physician to provide the best, most unbiased care. 

Q: How do you feel the internet and sites such as WebMD are contributing to healthcare?

What are they looking for?

  • Respect and consideration for your patient.  Simply that you can show you will listen to them. 

What to avoid saying

  • “Its destroying healthcare and making providers jobs more difficult”
  • “Your google search does not trump my medical degree” (even if you think it sometimes!)

What to say

  • There is a lot of information available on the internet.  If patients are able to find reliable information (CDC, Medscape) I think it can be helpful for patient education and awareness.
  • I don’t see much harm in it, at least it shows patients taking an investment in their health or illness and can provoke insightful questions and/or helpful information

How you might be pressed

  • What do you do when patients try and undermine your medical opinion? For example telling you they KNOW they need antibiotics.
    • Re-state their symptoms and tell them what was re-assuring about their exam.  A lot of the time when I get that “feeling” interviewing a patient that they won’t be happy unless they get an antibiotic as I go through their exam I make statements like “your ears look perfect, nice and clear” “lungs sound great to signs of infection” yada yada. 
    • If that isn’t effective I say “I understand your concern and if you would like I’d be happy to get one of my colleagues or collaborating physician for a second opinion” (this usually works)

 

The Hierarchy of Medicine & Minding The Gap

Medical careers have always had somewhat of a tough, rough and tumble appeal.  It’s difficult to get accepted, get through school, residency, fellowships, boards, etc etc. We’re all these type A, rise-and-grind people. Whatever your particular career may hold, whether you are a nurse, doctor, PA, NP, Pharmacist.  The culture of medicine is BRUTAL and our jobs are difficult enough, so I pose the question: why are we making it more difficult on each other?

Who remembers being a PA/RN/Medical Student and being terrified of Residents or Attendings?  Allow me to raise my hand first. I cannot help but think how backwards this is.  Think about it, we are in a field that most people would say they enter to “help people”.  That is what we write in our personal statements and tell admissions committees I guarantee it. So, if we are truly in the business of helping people and “working as a team” why am I getting yelled at for calling an on call Fellow Physician at 2am? Why do I hear providers yelling at nurses? Confession: I’ve done this. Second confession/further information: Don’t page me “Pt has a fever.  Please advise” when they already have Tylenol ordered. (If I had a dollar…)

Ok, anyways I’m getting off track. When did medicine become a culture of “I’m higher up than you so I can yell at you/treat you like crap?” Back to that 2am call to a Fellow Physician: If you do not want to be woken up, don’t be a GI doctor– it will require call. Second, since when did I have to apologize for waking someone up because I have a patient that truly needs you to get your ass up and come in and do something?  You chose this, you wanted to pursue this career and help patients.  Get up. Put on your shoes and get your ass to the hospital. No, I didn’t say this– but I thought about it.

Perhaps the greater question is: Does this behavior and interactions harms patient care?  Especially in a hospital setting at teaching institutions where environments can be quite cut throat and hostile.  Residents fighting for cases, PA’s trying not to get their ass chewed out by fellows and attendings, providers getting pissed at nurses, nurses getting pissed at CNA’s. etc etc.

Like I said, have I been guilty of being an asshole when I’m dead tired and can’t handle another trivial request? Yep, sure have. Am I proud of this? No.

Listen, the reality about medicine is that you deal with people all day and it gets rough and sometimes you lose your shit.  (I hope I’m not alone here) Have I let this realization alter me for the better?  Sure have.

I’ve been reading a lot of Brene Brown’s work lately.  In one of her books (I think it was “Daring Greatly”) she talks about how you are not who you say you are or who you want to be.  You are only what you do.  The difference between this, she refers to as “minding the gap”. The space between who you are/what you actually do and who you want to be/what you actually do. 

Everyday I look at my fridge where I have a dry erase board that says “Mind The Gap”. And I think about the person I want to be in the present and how I want to become better every day.  Am I perfect? Hell no.  Am I trying? Hell yes.

 

Breaking Down PA School Interview Questions X

The PA career is incredibly competitive to enter.  Despite the number of programs out there and more popping up every year, your chances of acceptance are 1-2%.  For example the year I applied to Pitt there were well over 1,000 applicants and 40 seats.  THAT IS CRAZY TO ME! It makes me so thankful that I was able to earn acceptance, participate in such an amazing career and now help and interact with some really great Pre-PA students!

Q: Why should we choose you over other applicants?

What are they looking for?

  • You can demonstrate that you are confident and have earned the right to be in their program.  
  • Confidence
  • Assertiveness
  • You can clearly and concisely state why you are an excellent candidate
  • You’ve prepared  

What to avoid

  • Not having an answer.  
  • Being tentative. If you hesitate this demonstrates that you haven’t thought about this question or even worse that you don’t know how to answer it.  
    • A candidate who sits that and hims-and-haughs like “well….”, “ummmm”, or “I think….maybe…” Cut the crap say why you’ve earned this! Someone who hesitates or looks like they can’t give an answer isn’t someone an admissions committee correlates with a successful PA student.

What to say

  • I was not asked this questions; but, I did prepare for it.  My answers would have been as follows:
    • My tenacity.  By and far my first quality that sets me apart.  I risked a lot to take this course.  I also worked at times 4 different jobs to make ends meet and build experience and boost my application.  I did whatever possible to be successful in meeting this goal and I will demonstrate the same traits as a PA student and practicing professional.
    • My energy. I bring a great amount of energy into every situation I’m in and will put that energy towards becoming the best provider possible.  
  • Other great answers may include:
    • Perseverance
    • Diverse background
    • Maturity
    • Focus on wellness
    • Lots of time spent with underserved population
    • Substantial amount of clinical experience
    • Master’s Degree

I Don’t Have Time VS. It’s Not a Priority.

I cannot emphasize how much “I don’t have time” correlates to “It’s not a priority.”  I challenge everyone to take the phrase “I don’t have time” and replace it with “It’s not a priority”.  I guarantee you that it will be eye-opening.    

Quite frequently I have individuals who talk to me about my workout regimen and my food prep and I’m amazed at their ability to find reasons as to why I am able to do the things I am able to do for my health and how those reasons correlate to why they absolutely cannot.  
The most recent incident occurred as someone proceeded to tell me that I have time to workout because “I’m not responsible for other people”. Translation: I don’t have a husband or children.  First, I believe this is an excuse.  Do individuals who have families have a time management and priority challenge: yes. Do individuals like me have a priority challenge?  YES. Everyone’s time management challenges are unique to them.  I feel as though others have attempted to make me feel that because I don’t have a family, my priorities and check lists of things to complete are somehow easier to accomplish or not as important as those with families/husbands/wives.  I proceeded to tell this person that I work full-time. I run a side business and a website.  I have a dog that is a priority and I make sure she has food prepared and gets a walk 6 days a week. I spend a lot of time on the website/blog and other projects I’m working on collaborating with other professionals.  I also spend a decent amount of time reading about medicine and investing into my career. 
Everyday I wake up at 4:45am. I go to the gym participate in group crossfit class 5-6 days per week and 3 days a week I do extra individualized programming.  I’m either out of the gym by 6:30 or 7:30am on days that I work depending on my programming.  I go home walk my pup and listen to my HIPPO education RAP, shower/get ready/pack lunch(already prepped for week)/eat breakfast. Any extra time is dedicated to editing statements or working on the website OR a special project I’m working on with National Physician Assistant Eduction (its secret for now 😉  I arrive at work at 9am.  9am.  By the time I get to work I’ve done more with my day than most people do with 12 hours.  Currently I work in an urgent care.  This morning in 3 hours and 15 minutes I have seen 11 patients and written most of this blog.  Any down time at work I spend editing, reading medicine or responding to emails. 
We all have priority challenges.  We filter massive amounts of information, people and tasks daily and we decide consciously and unconsciously what we prioritize.  You are what you do, not who you say you are or what you say you will do. 
We all have the same 24 hours in the day, it’s all about finding ways to maximize every minute and hour afforded to you. 
I challenge everyone who reads this article– for ONE WEEK: Replace “I don’t have time” with “It’s not a priority” and I guarantee you will learn a great deal about yourself.  

Don’t Call Me Honey: An Open Letter to Patients Older Than Me 

When I enter a room with a patient I have a routine.  I knock, I introduce myself “Hi my name is Danielle, I’m a Physician Assistant I’m one of the providers here today”. I give a firm, confident handshake looking the patient in the eyes. I’m self assured and confident–not cocky, confident. I’m 32 years old.  I have a bachelors degree and two masters degrees.  I look like I’m about 18 and at least once per day I get asked “Are you old enough to do this” or get called “Honey” or “Sweetie” or “Dear”. 

Let me be clear, when older adults call me these things in different contexts of my life such as someone holding a door at Starbucks or in the check out line at the grocery store it doesn’t irritate me.  Hell, thanks a lot I’m 32 and you probably think I’m in my early twenties.  

However, when you walk in to a providers office I view these potential “terms of endearment” quite differently.

  1. Just because you are older than me doesn’t mean that you have better judgement with your google search

    Let me be clear, I don’t disregard statements my patients make.  Many times per day I have patients that come in and say “my kid just isn’t acting right” or “Every time I have a UTI this is what it feels like”.  However, you walked in to this office and you are paying for my medical opinion and clinical judgement. If I am unsure of something, I am the first person to directly tell my patient and seek a second opinion.  Until that time, please remember that you sought out a medical professionals opinion.  Again, let me be clear it isn’t that I don’t listen to my patients.  I understand when a patient says “Yea, my fever is only 99.5 but I am never about 97 or 98” or “Last time this happened I ended up with pneumonia because it wasn’t treated right away”.  Those are important things to know, and I am more than happy to hear those statements–hell it helps my clinical judgement. Saying “honey I looked this up on the internet and this is what it is,” is rude and disrespectful.  Don’t talk at me, speak with me. I give you this same respect and decency, please give me the same.

  2. Its degrading

    I’m not “honey” or “sweetie” to you.  I’m your medical provider. I’m here to offer the solution I believe based on my clinical judgement and education best suits the ailment or symptoms you are presently experiencing.  Also, dare I ask the question: If I were a man would you still use these terms? If I were older or looked older or always wore a white coat–would you make these statements? Perhaps, but I do strongly believe that it is geared towards the female gender and that if I were a man it wouldn’t occur nearly as frequently.  

  3. Your terms of endearment undercut my education.  

    You may not intend to do this, and maybe I am misinterpreting.  Think about it, we frequently call small children “honey” and “sweetie” or “dear”.  They sure don’t have the education or intellect necessary to perform a clinical assessment and prescribe treatment.  Using the terms you use to speak to children makes me feel like you do not respect me as a professional medical provider.  Period.

  4. Please do not ask me if I am “Going on to Become a Physician”

    Ok, confession this doesn’t quite fit the mold of this blog.  However, I am a Physician Assistant.  It is a profession and a damn good one.  In fact it is projected to be the #1 Masters degree and profession through 2025 at this time.  We are not in 1970 where “people just don’t know what it is”.  This is 2016.  PA programs are more competitive by the numbers to earn acceptance than medical school.  I am not a medical assistant, nurse or resident.  I’m a PA.  If you want to know more about my profession, please ask me I am happy to speak with you about it.  But please, please do not ask me when I’m becoming a physician.