I would like us to discuss these two words and their meaning in 2025. Everything in life is an ongoing transition. I can look at my head and understand that a transition has taken place over the years: what was brown is now gray or bald. A 25-year-old PA student once had smooth skin, full of a natural flush; after practicing medicine for 20 years, there are noticeable changes that have taken place. The skin has become wrinkled from years of study and working on an EMR, hair has lost its natural luster, and the bright shine has undergone an evolution as it has become dry. The parents of a new infant look expectantly at their beautiful, happy baby. When that child is 19, their darling baby has become a senior teenager who makes new demands of mom and dad and does not seem to be so cute anymore. We still love them, but we have developed a two-way conditional love. On January 20, 2025, we had a major transition in government where the congress has now become the GOP Congress, and we have a newly elected president who has won both the popular and electoral vote. We observe changeovers in all departments of government and newly sworn in secretaries of federal departments. Whether or not we are delighted with every executive order or not, President Trump is in power, and his legacy will fall on his decisions, not our wants and needs. This is the same in hospital administration: we are not the decision makers, although we should endeavor to give constructive input and must derive satisfaction from our efforts.
Another transition that has taken place is that an entire new class of PA students has graduated. and has taken their certification exam. They now proudly wear a nameplate that describes them as PA-C, Physician Associate or Physician Assistant Certified. They have left the training ground of the classroom and rotations and are now applying their education and science to treat the 330 million patients of our United States in their medical or surgical specialty. Some have switched to academia and are beginning to teach formal courses, while a smaller group have started their ongoing doctorate degrees to prepare for an inevitable future. The smart newly-minted PAs have made their purchases to ensure greater accuracy in their equipment and have made that critical decision of obtaining a malpractice policy, a personal liability insurance policy which is occurrence in nature that ensures them a safety net for things such as failure to diagnose or treat according to a standard of care. Tonight, I just read of an 18-million-dollar judgement for failing to diagnose breast cancer which caused the 22-year-old patient to have a bilateral mastectomy and chemotherapy and results in decades of shortened life. Yes, we are living in perpetual transition. We are not perfect, and we have and do make medical errors: such is the fact of providing medical care. We study, we improve, but not unlike our chiefs of service, no medical professional is perfect, which is why we should never point our fingers or make comments.
The second thought is focused on transformation. I speak to this issue to describe the methods of care and our approach to the patient. We have progressed from a didactic approach to patient care; we now gain insights from the total patient that can be put into play as we look for our differential diagnosis. We need to take a deeper look at our patients, without hiding behind the EMR. Over the next few years, we will develop greater insights as we add the ingredients of empathy and perception and look beyond a disease and discover a patient in a new light. We examine apprehensive, anxious people who have multiple fears and concerns that go beyond their cancer or mental illness. The patient thinks of the ramifications of our diagnosis and how it may change their lives, occupations, families, finances and spirituality. The professional NP or PA has developed a Marcus Welby personality without becoming a physician. They develop a profound interest in what their patient may be thinking and are holding a hand in a kind manner to help this person navigate through the inevitable challenges and changes that they must confront. They are becoming compassionate counselors who have identified themselves as being on the patient’s team. I am a PA dinosaur who practiced for 47 years and worked twice as many hours as many of my colleagues. I practiced surgery and emergency medicine and took additional call. I served on a trauma team. I had the responsibility to inform the parents of a 17-year-old high school football player who died on the on the football field; and having looked at his CXR saw a terribly enlarged heart from a congenital hypertrophic cardiomyopathy. Or sitting with the parents of a drowned three-year-old who managed to get to the swimming pool which was not locked by either parent. I could foresee a challenging time ahead for them as they tried to process the guilt. They would need years of professional counseling .
Transitions and transformation: yes, hopefully we all manage to encounter them and become truly sensitive professionals and caregivers, as this is our road ahead and one that I hope all of the readers of this missive will take, acknowledge and become comfortable on the road less traveled.
Happy Valentine’s Day. Bob
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
