Saturday, December 30, 2006
Season's Greetings!
I want to extend best wishes to all of Canada's PAs and to wish you health and happiness for the coming year. I hope you managed to get some down time to re-charge your batteries and to spend some quality time with family and friends.
Sunday, December 17, 2006
Expectations
1. If the anonymous pathologist would like to participate in a dialogue, please identify yourself. We can continue in a less public conversation if you wish. I welcome your comments (and welcome the opportunity to converse on the subject) but the wording of them is intended to induce a response (a dialogue).
2. Clearly, there are unrealistic expectations being put upon PAs (locally). If what is desired is simply to retain, or regain, the status quo (no PAs), negativity will prevail. If fault is sought, it will be found. If the introduction of PAs is viewed as an opportunity and a challenge rather than an impediment, good things may be realized. PAs are here -- to stay, I hope. I'd suggest that the best of this purportedly 'bad' situation be made for the public's, if not for the hospital's, the department's or even the pathologist's sake. A look at the rest of the continent, at medium- and large-scale teaching organizations, may serve to illustrate the type of relationship that exists between pathologists, clinicians and PAs. Rather than attempting to ostracize, criticize and isolate the PA(s) with whom you are forced to work, include them so that they may be aware and informed. I doubt that the relationship that pathologists have with histotechs (with whom they interact many times each day; both as friends and fellow professionals) could be interpreted as "baby sitting." Au contraire, there are many real friendships that have sprung up between pathologists and histotechs. Yet, the PA sits alone in the grossing room awaiting the next critical comment; usually several days after the grossing of the specimen ("Why didn't you take sections of...?!). How about being proactive? A pathologist (the same pathologist who would be responsible for grossing or frozen sections) ought to be responsible for the goings-on in the gross room and ought to visit EACH morning to review the complex specimens with the PAs and to be available throughout the day to field questions from the PAs. If nothing else, the pathologist and the PA will become acquainted. More importantly, this sets up a teaching environment wherein the pathologist can answer questions and give direction to the PA.
Manuals are finally being created for the area. The pathologists will be asked to provide input into the first round of revisions of the policies and procedures. The manual will be used by whomever (PA or pathologist) is performing the gross and this standardization will go a long way towards an overall improvement in the quality of the surgical pathology 'product.' The manual, in and of itself, acts as an instructional document for the PAs as it will also attempt to give insights into why specimens are handled and sectioned in a particular manner. A means by which the pathologists may become proactive is by becoming involved in the discussions surrounding the wording of the procedures. As the Interior migrates toward an educational environment, these manuals will also serve as invaluable resources for pathology residents (who, like PAs, may be reluctant to admit that they have a lot to learn and who would far prefer to consult a manual than, heaven forbid, ask the pathologist and admit that they were overwhelmed by the flood of information when the pathologist explained how to describe and section a specimen the first time -- remember when you were a resident?). Needless to say, manuals are an absolute requirement of any quality-based facility -- something that many of us are becoming more and more deeply involved in -- and for good reason. "Document what you do" (namely, create a manual) and "Do what you document" (namely, abide by the manual).
PAs care as much about the patient (and about their continued employment) as any healthcare professional. Given the right tools and knowledge, they will perform their task with the same level of excellence as the others with whom they work each day.
2. Clearly, there are unrealistic expectations being put upon PAs (locally). If what is desired is simply to retain, or regain, the status quo (no PAs), negativity will prevail. If fault is sought, it will be found. If the introduction of PAs is viewed as an opportunity and a challenge rather than an impediment, good things may be realized. PAs are here -- to stay, I hope. I'd suggest that the best of this purportedly 'bad' situation be made for the public's, if not for the hospital's, the department's or even the pathologist's sake. A look at the rest of the continent, at medium- and large-scale teaching organizations, may serve to illustrate the type of relationship that exists between pathologists, clinicians and PAs. Rather than attempting to ostracize, criticize and isolate the PA(s) with whom you are forced to work, include them so that they may be aware and informed. I doubt that the relationship that pathologists have with histotechs (with whom they interact many times each day; both as friends and fellow professionals) could be interpreted as "baby sitting." Au contraire, there are many real friendships that have sprung up between pathologists and histotechs. Yet, the PA sits alone in the grossing room awaiting the next critical comment; usually several days after the grossing of the specimen ("Why didn't you take sections of...?!). How about being proactive? A pathologist (the same pathologist who would be responsible for grossing or frozen sections) ought to be responsible for the goings-on in the gross room and ought to visit EACH morning to review the complex specimens with the PAs and to be available throughout the day to field questions from the PAs. If nothing else, the pathologist and the PA will become acquainted. More importantly, this sets up a teaching environment wherein the pathologist can answer questions and give direction to the PA.
Manuals are finally being created for the area. The pathologists will be asked to provide input into the first round of revisions of the policies and procedures. The manual will be used by whomever (PA or pathologist) is performing the gross and this standardization will go a long way towards an overall improvement in the quality of the surgical pathology 'product.' The manual, in and of itself, acts as an instructional document for the PAs as it will also attempt to give insights into why specimens are handled and sectioned in a particular manner. A means by which the pathologists may become proactive is by becoming involved in the discussions surrounding the wording of the procedures. As the Interior migrates toward an educational environment, these manuals will also serve as invaluable resources for pathology residents (who, like PAs, may be reluctant to admit that they have a lot to learn and who would far prefer to consult a manual than, heaven forbid, ask the pathologist and admit that they were overwhelmed by the flood of information when the pathologist explained how to describe and section a specimen the first time -- remember when you were a resident?). Needless to say, manuals are an absolute requirement of any quality-based facility -- something that many of us are becoming more and more deeply involved in -- and for good reason. "Document what you do" (namely, create a manual) and "Do what you document" (namely, abide by the manual).
PAs care as much about the patient (and about their continued employment) as any healthcare professional. Given the right tools and knowledge, they will perform their task with the same level of excellence as the others with whom they work each day.
Sunday, December 10, 2006
"Credible"
I received an interesting comment to my previous post, presumably from a Pathologist, which stated that s/he had not yet met a credible pathologist who would endorse a PA (but also considered that the PAs with whom s/he had worked were not worth endorsing).
I wonder if it is a safe assumption that this person has a low opinion of any pathologist who would endorse a PA. More likely, this person is not happy with the 'product' provided by her/his PAs (assuming s/he has PAs).
I recognize that there are many political issues and biases with which a few have had to deal if their experience with PAs is relatively new. It is a challenge for the PAs as well. PAs are not perfect; no one is. A pathologist who views a PA as an extension of her-/himself and teaches and encourages that PA to provide the quality of work that is required, is one who has, in my opinion, the correct attitude. If one is looking for faults, one is certainly going to find them, no matter who one is looking at. PAs are not MDs. Without hands-on support and supervision, they ought not be expected to have the same insights into the subtle nuances (even the not-so-subtle, for that matter) of pathology as pathologists have. This is not to say that they cannot, with the appropriate training, do perfectly adequate Gross Descriptions however. PAs depend upon the active input of pathologists into their day to day practice in order to improve their knowledge base so that they may provide Gross Descriptions which more and more closely approximate those which would be rendered by pathologists. I'd suggest that if the person commenting is dissatisfied with her/his PAs, that s/he: 1. hire individuals with a better background (a BSc will soon be the prerequisite for admission to a PA training course in Canada, as has long been the situation in the USA) and, more importantly, 2. provide on-going support for the PAs by giving regular feedback and instruction.
There is currently no college, in any province, for PAs. Any CME activities are purely optional and self-directed (if not by the employer or pathologist). With minimal encouragement, most PAs will gladly participate in seminars and rounds in order to further their knowledge so that they can improve the quality of their work. They will, in fact, do this even though they cannot claim CME credits (yet). I encourage all pathologists, whether they are just getting to know PAs or whether they have had PAs working for them for years, to continue to work WITH their PAs, rather than apart. Given the chance, PAs can be very good team players.
I wonder if it is a safe assumption that this person has a low opinion of any pathologist who would endorse a PA. More likely, this person is not happy with the 'product' provided by her/his PAs (assuming s/he has PAs).
I recognize that there are many political issues and biases with which a few have had to deal if their experience with PAs is relatively new. It is a challenge for the PAs as well. PAs are not perfect; no one is. A pathologist who views a PA as an extension of her-/himself and teaches and encourages that PA to provide the quality of work that is required, is one who has, in my opinion, the correct attitude. If one is looking for faults, one is certainly going to find them, no matter who one is looking at. PAs are not MDs. Without hands-on support and supervision, they ought not be expected to have the same insights into the subtle nuances (even the not-so-subtle, for that matter) of pathology as pathologists have. This is not to say that they cannot, with the appropriate training, do perfectly adequate Gross Descriptions however. PAs depend upon the active input of pathologists into their day to day practice in order to improve their knowledge base so that they may provide Gross Descriptions which more and more closely approximate those which would be rendered by pathologists. I'd suggest that if the person commenting is dissatisfied with her/his PAs, that s/he: 1. hire individuals with a better background (a BSc will soon be the prerequisite for admission to a PA training course in Canada, as has long been the situation in the USA) and, more importantly, 2. provide on-going support for the PAs by giving regular feedback and instruction.
There is currently no college, in any province, for PAs. Any CME activities are purely optional and self-directed (if not by the employer or pathologist). With minimal encouragement, most PAs will gladly participate in seminars and rounds in order to further their knowledge so that they can improve the quality of their work. They will, in fact, do this even though they cannot claim CME credits (yet). I encourage all pathologists, whether they are just getting to know PAs or whether they have had PAs working for them for years, to continue to work WITH their PAs, rather than apart. Given the chance, PAs can be very good team players.
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