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Tales of the unexpected—and the lessons therein for us all

Bushardt, Reamer L. PharmD, RPh, PA-C

Journal of the American Academy of PAs: August 2011 - Volume 24 - Issue 8 - p 15

Reamer L. Bushardt, PharmD, RPh, PA-C, is the editor in chief of JAAPA. He is professor and chair, Department of Physician Assistant Studies, Wake Forest School of Medicine, Winston-Salem, North Carolina.



There was a knock on the door, and then I was told there was an urgent call from my wife. In the 60 seconds it took me to get to a phone, I imagined about 20 different scenarios, from my wife and daughters being locked out of the house to horrifying thoughts of a broken bone, car accident, or sick relative.

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Life presents us with unexpected events.

They can be the most wonderful or awful moments of our lives. Imagine the last great book you read or your favorite movie. I bet the author or director surprised you or led you through some unanticipated chain of events that wrapped you up in the plot. A predictable book is painful to read. It’s annoying to watch a movie and know exactly what is going to happen next.

I picked up the phone, my wife told me what had happened, and I knew I needed to get home to help. I had spent the past month planning a retreat for my faculty and staff. We were right in the middle of a well-orchestrated series of activities that included analysis of performance metrics, passionate conversations about ways to enhance our curriculum, and deliberations on a new advisement process. My role as facilitator was to keep everyone on task and on time. I pulled our vice chair aside and asked her if she would take over. Some of you may know Gail Curtis, a familiar face among our profession’s leadership circles. She knew what needed to be done before I even got a couple hurried sentences out.

My wife and daughters are fine now, and now I can even see a little humor in the situation. My 2-year-old, Madeline, had awakened feverish and fussy. This was significant because she wakes up every day with a grin on her face and ready to conquer the world—unlike her father, who requires several strong cups of black coffee before he can even speak. Within an hour, she began vomiting. My wife scooped her up and headed to the bathroom, where Madeline’s vomiting combined with the tiled floors sent my wife off her feet and slamming first into the toilet, then against a set of cabinets. While trying to shield the baby from the fall, she did some damage to her arm and her back. To cap off an unpleasant morning, my 4-year-old, Isabella, having witnessed her sister’s gastroenteritis, promptly headed downstairs for quarantine. She refused to come back upstairs until someone assured her all the germs were gone. Regrettably, she had recently asked me how kids catch colds, and I had explained the communicability of common viruses and bacteria. Once home, I provided more reassurance than medical care and crafted a plan to get everyone properly checked out.

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As PAs, we must be always prepared to deal with the unexpected.

Although the frequency of unexpected events may differ by specialty, we are all subject to moments when we are called to action. Ironically, I have reflected that these experiences for me have occurred more commonly when I am behind schedule or in the middle of something important. I was concerned that my retreat would fall apart without me there to facilitate the discussions, but the discussions were lively and right on schedule when I arrived back on campus. The groups had even taken a few unexpected turns without me there to stick to my plan, and they had dreamed up several very creative and relevant new approaches to the challenges at hand. I realized first that my presence was not essential for the team to function well. I realized second that when you pass leadership or care of a situation to a PA—Gail Curtis, in this case—you can trust that it will get done. The message that PAs can extend care of the highest quality is one I have delivered for years to students, employers, legislators, patients, and anyone else who will listen. Today, I really get it.

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We all practice within teams.

In fact, PAs are defined by team-based practice. Just like the providers and staff in a family practice, my program faculty and staff are a team. We communicate often, which keeps us in touch with our priorities and shared goals. Does everyone on your team realize their work directly impacts the health and wellness of patients? Does each team member understand the roles, responsibilities, and major challenges of the other members? Do your team members actively collaborate and coordinate their efforts? Do you invite others to help solve problems, and do you in turn assist others in your organization such as reception staff, nurses, business managers, finance staff, and compliance officers? When a member is called away to deal with an unexpected event, the strongest teams not only survive—they actually thrive. Team-based quality improvement is increasingly important within our evolving health care system, especially for teams caring for patients with multiple chronic illnesses. These activities are also essential for providers within patient-centered medical homes and practices within accountable care organizations. As a PA, you have unique expertise in how to make a team highly successful and an aptitude for leadership through a deep understanding of why teams sometimes fail. Share this talent, and help your team become more prepared to face the unexpected.

© 2011 American Academy of Physician Assistants.