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P.A.s versus Doctors


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#1 JANQ

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Posted 10 February 2009 - 04:12 AM

Hello!

I am on the shy side, so it has taken some time for me to build up the courage to start a new topic. I have had many questions answered through reading the stories and questions by others. My big thank you to this forum!

My question is this: Are Physicians Assistants (PA's) qualified to diagnose and treat on their own? Are they required to consult with the doctor before doing so? I have tried to research this on my own, but have not come up with the answers.

My initial consultation was with the rheumatologist, the last 3 visits have been with the P.A. The P.A. came up with the diagnosis of UCTD and the treatment plan.

I brought 1 1/2 pages of symptoms on my second visit with the P.A. She barely glanced at it, and made no remarks about my symptoms. On the third visit, I brought a 1/2 page list of new symptoms and changes. This time, they were barely acknowledged, with only the remarks of "Did you tell the dermalogist?" or, "Did you tell your internist?" At that time, labs were done. The only correspondence regarding the labs was a "form" that was sent to me in the mail from the P.A. with a check mark next to "normal" on the labs, and a remark at the bottom of the form from the P.A. saying, "Labs look great!" Under other circumstances, I would be thrilled to hear this, however, my new symptoms and current overall physical conditions (which are bad) do not match what the labs are saying, and there was no opportunity to ask, since the correspondence was a mailed form letter.

It is disconcerting to me that I seem to be falling through the cracks. Two weeks ago, I requested copies of my labs, which I have never received. At the same time, my prescription for a different acid reflux medication (I am already on one) was denied by my insurance company. My pharmacy sent a fax to the rheumatologist's office, and as far as I know, nothing was done about it.

My next visit is in one month, this time with the rheumatologist. Do I bring up my concerns with him? Do I switch doctors completely? I would not be dissatisfied and disappointed if I felt like someone there was actually listening to me.

I am beginning to feel like they think that UCTD patients are not considered seriously sick enough to be seen by the doctor.

If anyone has any opinions or thoughts, please let me know.

Warmest wishes to everyone,

Janet

#2 PrincessB

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Posted 10 February 2009 - 05:07 AM

Hi there,

I think you should definitely say something, even if the PA will probably be moody with you when she finds out. I remember I saw my general practitioner once about an ulcer and he wanted to pull the crust off the top (the most excruciating pain imaginable) and only stopped when I cried so much his assistant came in to find out if he was killing me. So, he made me make another appointment for a few days later when he was going to take it off then. In the meantime, I got in touch with my specialist, not knowing that they know each other well, and asked him if what the general practitioner was doing was correct. Well, he told the general practitioner, who has never let me forget that I questioned his knowledge, but at least I had the peace of mind of knowing the specialist knew what was going on. And the general practitioner didn't take the crust off in the end, I think a behind-the-scenes talking to may have gone on.

All that (!) to say that if you don't feel comfortable, you should always question what's happening. No way does your PA care as much about what's happening to you as you do, so you should take charge as much as possible (which it sounds like you're doing anyway with your notes, very good idea).

Also, I'm from the UK, so I don't know what PAs are qualified to do, someone else will chime in, I'm sure. Good luck!
Diagnosed diffuse systemic scleroderma December 2005 (on my 30th birthday, as if turning 30 wasn't enough?!)

#3 Margaret

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Posted 10 February 2009 - 05:20 AM

Hi Janet ,

I went through the same thing with one of Gareth's doctors. He was always given the PA. I learned from the radiology tech that for every 2 visits to the PA, one should always be seen by the doctor the next visit. I do believe it is the law, but don't quote me on that. We live in Pennsylvania....it might be different in Idaho. I left that doctors office because he always saw the PA and I didn't like her. I hope you have that choice if needed.

Take care, Everyone.
Margaret

#4 annkd

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Posted 10 February 2009 - 07:53 AM

Hi Janet - your story sounds just like how my journey started with scleroderma. I first saw the rheumatologist and then for the next 3 or 4 visits I saw the PA. I told my internest about this (since he was the one who recommended the rheumatologist) and he got on the phone (with me sitting right there in his office) and asked the office to put him on the phone. He talked to him for a short time and asked what was the policy of their office and what should I expect in regards to my health care. Well, about three months later I changed rheumatologists. I am so glad I did because the PA thing just wasn't working for me. When you are first diagnosed you really need to have a good relationship with your doctor. Symptoms change and it is scary. Now I feel like I'm heard and it makes all the difference. Best of luck and keep us posted. Warm hugs, Ann

#5 debonair susie

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Posted 10 February 2009 - 09:22 AM

Hi Janet,

I am so glad you opted to start a thread, despite your shyness! This is a GREAT place to be, when it comes to the sharing of information.

To address your first question: Because you do have health issues of this magnitude,, you are right in feeling you should be seeing a doctor. I have nothing against PAs myself...I've seen some awesome ones!
Now, if I may ask...Do you have an internist? If so, this doctor could make referrals for you.

I realize doctors are overloaded, which is why PAs are utilized as they are. Any PAs I have seen, have always conferred with a doctor in the office, before treating me and most of the time that doctor even comes in to see me also.

In my humble opinion, you are well within your rights, when making appointments...to ask that the appointment be with a specialist...not a PA, especially when you have health issues going on.

You have every right to have your questions answered...to your satisfaction. As has been said before...press on until you do. It's important to be your own health advocate.

As for not receiving copies of reports/lab work you request...might I suggest you ask for copies while AT the dr's office...they can immediately print said information off for you right there!

Take care, Janet...I know you will get this accomplished...I KNOW you can do it!
Let us know how it all goes and stay touch, okay?

By the way...I am SO glad you posted...you are NOT alone in this!
Special Hugs,

Susie Kraft
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#6 Peggy

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Posted 10 February 2009 - 11:13 AM

A huge welcome and I'm so glad you posted!

I have come to the realization in what I've had to go through with the medical field with this disease that I am going to come first and that's just the way it is. I am no longer going to be a pansy and just take terrible treatment. So in that regard being you or your insurance is probably being billed the same amount to see the PA as it would if you saw the doctor that you want to be seen by the doctor. You should have that choice. If you aren't comfortable with the PA then make that noted with the scheduling clerk and when you make your next appointment tell her you want to see the doctor not the PA. If they don't like too bad. You're the patient and it's your choice not theirs.

It took a year for me to find out what was wrong with me. With each appointment and each different doctor I was told I had one thing or another and at one time I was told that I should see a psychistrist. I still trodded on as I knew something was wrong and didn't give up and thankfully got in front of a doctor who took me seriously and was truly concerned to get to the bottom of it. Now I have found that I have 6 different autoimmune diseases and also have been told lymphoma will present at some time. What if I had given up?

You are the patient and what you want is what you should get. A PA is not a doctor and it sounds like she isn't even a good PA.

I wish you good luck and please let us know how you are doing. This is a great place to come to vent, ask questions, and get great advice.

Warm hugs,

Peggy

#7 Shelley Ensz

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Posted 10 February 2009 - 11:34 AM

Hi Janet,

It is my understanding that physician assistants (PA's) are generally able to diagnose and treat most diseases, but under the supervision of a physician.

The advantage is that you are usually able to schedule longer appointments with them (perhaps a half hour or even an hour in some cases) rather than the 10 or 15 minute appointments usually allotted for the doctor. This can be an advantage when you have a complicated health situation, and more than one simple issue to deal with per appointment.

I used to have a PA that was truly great, better than many doctors I've been to. She was also more empathetic, so it was funny in support groups how many people who had her would report crying at most of their appointments -- really out of shock that finally, a medical professional actually seemed to care how they were doing. I thought that was actually kind of funny, until I ended up being seen by her one day, and low and behold, within 15 minutes I was crying too!

But it was a good kind of crying, the sort that is both healing and refreshing. So if you have a good P.A., they are worth their weight in gold. In clinics that use P.A.'s, I believe they use them in rotation with the doctors and it is not based on how sick you are, I.e. that patients who are taken more seriously are only given the doctor. Rather, it is my impression that it's more of an across-the-board sort of distribution.

However, I may be wrong -- I often am! And if you ever land in my old P.A.'s office, remember to bring your handkerchief.
Warm Hugs,

Shelley Ensz
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The most important thing in the world to know about scleroderma is sclero.org.

#8 jefa

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Posted 10 February 2009 - 10:52 PM

Welcome to the ISN Sclero Forums, Janet. I am so glad you have decided to jump right in with a thread. We don't have PAs in the same sense in the UK, but many rheumatology clinics are in teaching hospitals, so we rotate seeing junior medical people with our rheumatologists. As Shelley mentioned, I often spend more time with those and questions get raised that wouldn't in other circumstances. Sometimes, they will even go and get the rheumatologist to discuss something so I get both and the opportunity to hear him discussing with someone else from a different perspective. The quality of the service is dependent on the quality of the teacher involved.
Warm wishes,
Jefa

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#9 JANQ

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Posted 11 February 2009 - 02:22 AM

Thank you all for your responses! It helps me so much to know what is within my rights as a patient and what I should be expecting. Thank you, also, for sharing your experiences. It saddens me so much to hear of the bad experiences, but gives me hope after hearing the good ones. I am so glad that no one ever gave up!

After 20 years with a general practitioner who never once listened to me to go beyond the routine blood tests, I did find a wonderful internist in September of 2008. It only took her six weeks to find my elevated ANA, and after years of frustration, sad to say, I was actually elated when she told me! Finally, I could get help and on the road to recovery!! She referred me to my rheumatologist, but since then, my elation has turned to disappointment (and depression) since I seemed to be falling through the cracks, just as I had with my former general practitioner.

I really did not know if it was within my rights to see my own lab results, but it sounds like I have every right to do so and to request copies. After requesting them on the phone and not receiving them, I thought that I was stepping on toes, requesting something that was only to be seen by the medical professionals. I also did not know if questioning my own care would ruffle feathers, which I did not want to do, but it sounds like that shouldn’t even matter.

I will definitely ask for the labs when I am there on my next visit, rather than through a phone call. I was uneasy with my visits with the P.A., for one, because she never went through the labs with me other than to comment for a few of the tests, “This one tells us….,” and the big question for me was, “What is this one specifically and what were the others?” I even explained on my last visit that I may not understand, but I wanted to know, and if I did know which tests were run and the results, I could always research on my own. She still didn’t go into detail. Also, never once has the doctor stepped in during my appointments, which have actually been no longer than 15 minutes, and never once have I seen her consulting with him on any of my visits. The P.A. did tell me that “My diagnosis is UCTD,” and “My treatment plan is…,” which lead me to believe that she does not consult with the doctor, but I may be wrong.

Now another big problem…developing a backbone so that I can follow through as necessary!! (Yes, I am working on this!)

Thank you so much again for your input.

Take good care, everyone.

Janet

#10 Sweet

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Posted 11 February 2009 - 05:03 AM

Hi Janet,

Welcome to the Sclero Forums. I'm so glad you posted! I'm a nurse and have been in the medical field for 27 years, mostly in management - I have a Masters in Health Administration, and have done my fair share of hiring/firing doctors and PA's. Some of my favorite providers are PA's. They can diagnosis and treat. They have a preceptor (MD/DO) that they work under, (on paper only) and don't have to consult with them unless they have questions. (States vary in rules however) In my experience most of the time you will receive better care from a PA than a MD. Most of them are nurses in a previous life, and then return to school for further training. So normally they demonstrate more of a caring side to them. HOWEVER, I think in any profession, you will get a lemon along the way. As a patient you have the right to see who you want, and to fire any given provider you are uncomfortable with. Remember, you're paying the bills, they work for you!

So with all of that said, I think there are some great PA's out there, some great MD's out there, and some less desirables. You pick the one you feel is taking the best care of you.
Warm and gentle hugs,

Pamela
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International Scleroderma Network (ISN)

#11 anderson

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Posted 12 February 2009 - 07:15 AM

Janet,

I am sorry you are having such a rough time. PA's work under doctors and can diagnosis and treat. I personally sometimes prefer to be seen and treated by the PA's. Don't let them blow you off. You are going to be the best advocate for you. I am sorry about your frustration. I would talk to the doctor regarding your treatment by the PA.

Good Luck,

Anderson