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Musings: Blog of the JAAPA Editorial Board

Musings

Blog of the JAAPA editorial board.

Monday, May 20, 2019

The second annual iScan student workshop and competition is today from 7:30 a.m. to 4 p.m. in Mile High Ballroom 4. Student teams will show off their ultrasound skills across a variety of clinical circumstances. Come see the difference that point-of-care-ultrasound can make in your practice and join the pros in the hands-on ultrasound bullpen. See how easy it is to obtain, interpret, and implement ultrasound into your clinical practice.

Are you interested in writing for publication? Join JAAPA editors and editorial board members from 1-3 p.m. today in room 104 for a workshop on how to craft your manuscript to inform and educate your readers and successfully pass peer review and nitpicky editors. If becoming a peer reviewer is your thing, head to room 104 at 3 p.m. today for a 2-hour hands-on workshop on how to give constructive manuscript criticism. The peer review workshop is led by JAAPA editor-in-chief Reamer L. Bushardt, PharmD, PA-C, DFAAPA, and JPAE editor-in-chief David Asprey, PhD, PA-C.

Be sure to come out at 7 tonight to cheer your favorite team on at the National Medical Challenge Bowl. As part of the festivities, JAAPA will formally present awards to these winners of the 2019 Tanya Gregory Student Writing Contest:

• Clinical or research category: “Post-traumatic stress disorder in veterans: Treatments and risk factors for nonadherence” by Bradley Haveman-Gould, MHS, PA-C, and Chelsea Newman, Novmeber 2018 issue. Ms. Newman was a student in the PA program at Drexel University in Philadelphia, Pa., when the article was written. Mr. Haveman-Gould practices neurology at Mercy Health Physician Partners in Grand Rapids, Mich., is an adjunct faculty member in the PA program at Drexel University, and is an assistant clinical affiliate faculty member in the PA program at Grand Valley State University in Grand Rapids.

• Humanities category: “The truth about PA school,” by Kathleen Di Simone, MS, PA-C, October 2018 issue. Ms. Di Simone was a student in the Touro College Manhattan PA Program in New York City at the time the article was written. She now practices emergency medicine.

Honorable mentions go to:
• Alanna M. Balbi, BS; Amanda A. Van Sant, PA-C, MSPAS; Eric W. Bean, DO, MBA; and Jeanne L. Jacoby, MD, FACEP, for their May 2018 article, “Mumps: Resurgence of a once-dormant disease.” Ms. Balbi is a medical student at the University of South Florida in Tampa, Fla. Ms. Van Sant practices in the ED at Lehigh Valley Health Network in Bethlehem, Pa. Dr. Bean is an emergency medicine physician at Lehigh Valley Health Network. Dr. Jacoby is assistant research director and an attending physician in the ED at Lehigh Valley Health Network and a clinical associate professor in the University of South Florida’s Morsani College of Medicine.
• Emily Simpson, MMSc, PA-C, and Heather L. Brown, MS, PA-C, DFAAPA, for the August 2018 article, “Understanding osteosarcomas.” Ms. Simpson was a student in the PA program at Mercer University in Atlanta, Ga., when the article was written, and now practices urgent care medicine with Georgia Emergency Associates in Savannah, Ga. Heather L. Brown is an adjunct assistant professor in the PA program at Mercer University.

Saturday, May 18, 2019

​Conference registration is open from 7 a.m. to 6 p.m. today through Tuesday. A blood drive will be held in room 610 from 9 a.m. to 3 p.m. today and Sunday. Looking for a first job, or a job change? Visit the Career Fair in Mile High Ballroom 4 between 8:30 a.m. and 2:30 p.m. to meet with recruiters from various healthcare facilities.

Hear keynote speaker Allison Massari at the general session at 4 p.m. today in the Bellco Theatre. Ms. Massari suffered severe burns in a 1998 car crash; 3 years later, she sustained a closed-head injury in another accident. These life-changing injuries gave her a perceptive view inside the patient experience. She’ll inspire you to remember why you chose healthcare in the first place and enhance your patient relationships by tapping into compassion and kindness. See the value that you can provide to a suffering patient and hear solutions to keep your patients first despite limited time and other practical constraints.

After the general session, Ms. Massari will be signing prints of her art during the opening reception (6-7:30 p.m.) in Exhibit Hall F. You also can check out a rock-climbing wall, play giant games like Jenga!, and taste Colorado craft beers. The exhibit hall will be open from 6-7:30 p.m. today.

Saturday, May 18, 2019

​The exhibit hall is open 9 a.m.-5 p.m. today and 9 a.m.-1 p.m. Monday. Look for JAAPA and Wolters Kluwer at booth 403. Check out the floor plan here.

Today is the last day for the blood drive in room 610. Stop by between 9 a.m. and 3 p.m. to donate.

Enjoy hors d'oeuvres and drinks as well as unlimited bowling, pool, arcade games, and live entertainment at the Party with a Purpose from 7:30-10:30 p.m. tonight at Punch Bowl Social. Proceeds from this event benefit the PA Foundation.

Pictured: WK booth 2017

Monday, October 8, 2018

Brian T. Maurer, PA-C

In a recent research article, Coplan and colleagues looked at burnout, job satisfaction, and stress levels of PAs. Analysis of data gleaned from the 2016 American Academy of PAs salary survey shows that, in general, PAs experience modest levels of burnout at work. Nearly 57% of PA respondents rated spending too many hours at work as an important contributor to stress. Job dissatisfaction correlates with lack of opportunities for promotion, relatively low income given the level of clinical responsibilities, an inability to provide patients with the quality of care they need, too many bureaucratic tasks, increasing computerization of practice, too many difficult patients, and difficult colleagues or staff in the workplace.

Suggested strategies to reduce burnout and improve the work lives of clinicians include interventions to streamline workflows, strengthen teamwork, and promote flexibility and work-life balance.

In a separate opinion piece in STAT, Talbot and Dean take the issue of clinician burnout to another level, that of moral injury, defined as an inability to provide high-quality care and healing in the context of healthcare delivery.

“[B]urnout is itself a symptom of something larger: our broken health care system,” they write. “The increasingly complex web of providers’ highly conflicted allegiances—to patients, to self, and to employers—and its attendant moral injury may be driving the health care ecosystem to a tipping point and causing the collapse of resilience.”

In their opinion “without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the consequences.”

Talbot and Dean argue that establishing clinician wellness programs won’t solve the problem. “Nor will pushing the solution onto providers by switching them to team-based care; creating flexible schedules and float pools for provider emergencies; getting physicians to practice mindfulness, meditation, and relaxation techniques, or participate in cognitive-behavior therapy and resilience training.”

Instead, they propose “[a] truly free market of insurers and providers, one without financial obligations being pushed to providers, [to] allow for self-regulation and patient-driven care.”

In a subsequent STAT opinion piece, Morris-Singer, Pollack, and Lewis offer an additional take on addressing the issue of healing moral injury:

“While the sources of professional dissatisfaction vary, the sources of fulfillment are consistent: It’s all about connection—to patients, to colleagues, and to the calling of medicine. Indeed, nearly three-fourths of providers view their relationships with patients as the most meaningful part of their work.

“[U]niting and building community must be the first step” in the process of healing moral injury.

Brian T. Maurer has practiced general pediatrics for more than 30 years. He is the author of Patients Are a Virtue and blogs at http://briantmaurer.wordpress.com. The views expressed in this blog post are those of the author and may not reflect AAPA policies.


Monday, July 30, 2018

Ellen D. Mandel, DMH, MPA, MS, PA-C

What does close reading mean to you? Do you think it means holding a book close to your eyes due to myopia? Maybe it means reading about a close relative or a topic close to your heart? Well, these are not even close to the definition. In the realm of narrative medicine, close reading means reading for a purpose, to discover things that would not be discovered or discerned with a casual reading approach. According to Rita Charon, MD, PhD, professor of medicine and director of the narrative medicine program at Columbia University, close reading might help train clinicians to notice more about what their patients are communicating, leading to many benefits. It helps us to read between the lines, and thus better communicate. Communication is a two-way street.1

In close reading, readers train themselves to clearly register a work of prose, poetry, and even musical lyrics, in terms of genre, narrator, diction, timing, space, plot, choice of vocabulary, and images.1 If your eyes are glazing over, thinking of Shakespeare, Henry James, Ayn Rand, or Walden Pond, I’m sorry. However, good quality literature lets us enter worlds that are unknown to us. It is especially important to do close reading if you had an idyllic and wonderful childhood, easily found the perfect life partner, achieved every goal with limited fuss, have more money than you know what to do with, had no one close die (pet or human), never been stereotyped or discriminated against, and generally have experienced nothing awful. Well then, honestly, close reading is essential. Frankly, you don’t know what you don’t know—scary. The reality is, every clinician will benefit.

Close reading lets clinicians see and nearly feel via the vehicle of a well-written work, domestic violence, murder, betrayal, lying, substance abuse, theft, adultery, death of the innocent, medical malpractice and a host of other unsavory activities, all from the safety of a comfy sofa (comforter included). It reveals individual and group differences in thought and behaviors based on religion, culture, morals, and ethics. It trains the PA student (often referenced as a millennial and by commonly voiced opinion, having an attention span of a short YouTube video), to carefully read a story and keep track of multiple characters, move back and forth in time (recall foreshadowing from English class), note discrepancies in plot, and stay on top of a story. Not so unlike collecting a history from a patient who does not present information in the accepted template order: possibly one with a low score on a mental status examination?2

Physicians, who have historically been fed a diet of myths about their perfection, are experiencing burnout, substance abuse, relationship fall-out, and suicide. Narrative medicine helps here, too.3 If it helps the physician, it will help the PA. Remember, we are trained in the medical model and also are subject to its risks and benefits. Close reading in groups has been shown to improve coping, resilience, and job happiness.4

So, set aside some time every day to ready a juicy book. Take it all in. Discuss it with others. Avoid War and Peace for now. Enter another world and fall into it. And please, take millennials by the hand, and bring them into close reading. All of you will learn, improve your patient communication skills, and get some relief from the less-than-rosy world we inhabit.


REFERENCES

1. Charon R. The Principles and Practice of Narrative Medicine. Oxford University Press, 2017.

2. Charon R. To see the suffering. Acad Med. 2017;92(12):1668-1670.

3. West CP, Dyrbye LN, Erwin PJ, et al. Interventions to prevent and reduce physician burnout: systematic review and meta-analysis. Lancet. 2016;338:2272-2281.

4. Sanchez-Reilly S, Morrison LJ, Carey E, et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013;11(2):75-81.

Ellen D. Mandel is a clinical professor in the Department of PA Studies at Pace University-Lenox Hill Hospital in New York City. The views expressed in this blog post are those of the author and may not reflect AAPA policies.