Monthly Archives: September 2011

late night studying: Salmonella or Shigella?


I haven’t exactly blogged about the ins and outs of how this is all happening,.. I try to stay fairly balanced as a grad student (dinner with Friends Fri night, volunteer at health fun run Sat morning, BBQ at other friends Sat night,. church,.. see there are some fun and games involved!)  With, a whole lot of studying in between.  Like today, with my long-suffering (because he has to put up with me) study partner Darrin.  At some point, however, one really has to ask oneself:

How many hours of differentiating between intestinal diarrheal disease can a girl take?  Especially when considering the color and texture of said diarrhea, as well as the exact way the responsible vermin is damaging the inside of the poor sod’s intestinal lining? 

Many hours, in fact, you can ask him.. and Marcus, who mostly tried to tune out our descriptive discussion.  And I’m still up late making sure I’ve packed every last gram negative rod into my egg-scrambled brain.  Moral of this particular story called “infectious disease,” is that if you want to avoid bacteria/viruses/squirmy parasites, there’s a simple solution: don’t be born.  If that’s not a good option for you, I advise that you just strap in for the ride because sometimes things can get,.. well,…. explosive.  (think Cryptosporidium).


Multicultural Women’s Health Fair :) Medicaid Presentation :(


I’m going to try really hard to not get political here, But I felt that my experience was worth sharing about!  I volunteered for a Multicultural Women’s Health Fair that they needed volunteers for, and spent about five hours there last Saturday.  The goal was to target women from different refugee or otherwise non-native ethnicities and provide information to them through four or five presenters.  The organization did a great job organizing it- the women were grouped according to language and provided with translators for Nepali, Swahili, Karen (Cambodia), Arabic, French and a few others.  The first presenter spoke about breast, ovarian, colon and skin cancers and included how and when to get screened, etc.  The second was a midwife, and she did a great job talking about general women’s health issues (menstruation, nutrition, cancers, when to see a health provider,. etc) although she said that “midwife” and “doctor” are interchangeable, which was very confusing to me.  I’ve never heard of midwives being considered general practitioners, but apparently in some states they can diagnose and prescribe,… I’ll have to look into that more!  I wish she would have used “nurse practitioner” and “PA,” because this particular population of women and their family members are more likely to see a midlevel provider at low cost clinics than MDs.  Anyway,… Then a gal talked about nutrition and finally, a representative from Medicaid spoke.

So, I have never heard a presentation on Medicaid, nor do I feel like I have an adequate understanding about who qualifies, their services,. etc etc.  But, I have to tell you, if I were to walk away from that presentation, the message that I would take is to go home and get pregnant.  Because, as she repetitively stated, pregnant women and children will not pay anything for any service at any time, if they are on Medicaid.  Period.  She seemed to be well meaning and knowledgeable of their system and services, but I was dismayed by her lack of “thinking outside the medicaid box” for this population of people.  She spent the whole time talking about how to apply (ok,. fine,) and listing off slide after slide of all the things that they will cover and pay for.  Now, to her credit, she could justify her talk as being about how to apply and what they cover and that she did just that, but I felt it was an enormously incomplete picture of reality.  Come to find out, it’s really difficult to qualify for Medicaid, even if you do not have a lot of money.  So, many of the women there don’t qualify anyway because they don’t have kids, or whatever else (go get pregnant).. And it just seemed like she was dangling this enormous carrot in front of a bunch of starved bunnies with the message that this particular carrot is the one you want, and the only way to it is through Medicaid!  If you want to be truly helpful, think big picture here.  Utah accepts any and all refugees.  But obviously, the hope is that they are responsible for finding jobs once they get here.  They get help, mentoring (thank you, Marcus) classes, and a lot of support, but eventually they are turned loose to join our society like everyone else.  Most of them, obviously, want to come here to start a new life, provide for their kids, and get jobs.  Most of them, are very hard working people.  So why on earth are Medicaid reps out there encouraging people to rely on social services like Medicaid, that many of them don’t even qualify for because they’re on the track towards self sufficiency?  Is this truly helpful?  If you would just be poor enough and go get pregnant, look at all the great services you will have!  I’m sorry, but that should not be the message we are sending.

She never said anything about private insurance companies, and that with education and good employment, insurance can be gained.  Obviously, she’s not licensed to represent private companies, but if many of these women don’t qualify for Medicaid, why aren’t we encouraging them to go to low-cost clinics, and explore private company options?  I’m sorry, I will not accept that there are no other options out there!  I have to give her credit, she did encourage them to not go to the ER unless it was an absolute emergency, but then again if you’re on Medicaid you won’t pay anything! or will pay just a few dollars!

We already have enough people in our country who are lazy, do not want to provide for themselves and expect the rest of America to foot their bill.  We should not be inviting refugees to our country and then encouraging them to join that group.  Instead, we should be encouraging people to move into the private sector with jobs, education and opportunity.   I doubt that Medicaid was ever intended to be a permanent solution for people.

Final thoughts… it was a disappointing first experience for me,… I felt like she misled them in thinking that they have a good chance of qualifying (how helpful is it to the rest of the women who don’t?)  In fact, a few women asked her questions about that- “my son turned 18 and was denied Medicaid, why?”  “we don’t qualify, what do we do?”  Her response was to point them towards other social services that might get them coverage.  It’s misleading because there are other options out there, there are low cost clinics, there are vaccination fairs, etc etc.  It’s misleading to send the message that here in America, people are entitled to free care, because as it stands, we do not have such a system in place.  Maybe we will someday, maybe not.  It’s discouraging them from being enterprising, and pursuing success through the work place. I felt like her goal was to steer people towards Medicaid, more than it was to educate and support refugee women.

And like I said, I would have walked out of there thinking to myself “I’m going to get pregnant, and then call all my relatives and tell them that if they come to America have enough kids (etc) they will never pay for health care!”

This message was a disservice to all of them, and to the rest of society.

And,. we’re back.


Yes, indeed I haven’t posted for a while, finals and all but I’m well on my way into term two! So what do I think so far? I have got to say that PA school has been one of the best decisions I’ve made in my life. I was just asked recently why I didn’t just choose to “go all the way” and go to Medical School. First of all, I don’t believe that going to PA school will somehow leave me short-changed, or missing out on crucial and/or necessary skills. Second, I felt that the question indicated that becoming a PA doesn’t command the same level of respect or require the same amount of work or dedication. Finally, I know for a fact that there are those within the medical school community that do not believe that PAs have a role in healthcare in our country. I feel that all three couldn’t be further from the truth.
I think that we all will find that as we interact with PAs in doctors’ offices, clinics, and hospitals across the country that they are just as skilled and prepared to treat patients as doctors and nurse practitioners. Well how can I say that, given that doctors spend so many more years in school? Because our residency is on-the-job, and we are required to re-certify every six years. Doctors don’t have to do that. So you will always know that your PA is up-to-date on their skills and knowledge base in all areas of medicine, even if they are practicing in a specialty. Finally, if PAs were not adequately prepared to treat Joe Schmoe who comes through the door on a stretcher, they wouldn’t be working in ERs across America. Obviously, if I wanted to be a surgeon, I’d go to Medical school. But I don’t. I will be able to perform many smaller surgeries, I don’t need to remove brain tumors, or replace knees. As for the second argument, if it was about having a fancy name plate or “DM” next to my last name, I’d go to Medical school. But it’s not. And let’s be honest, there are good plumbers, and bad plumbers. Good dentists, and bad dentists. Good doctors, and bad doctors. Good PAs, and bad PAs. I’d rather go to a good PA over a bad doctor, any day. So, the argument that seeing a doctor is better than seeing a PA is invalid. I have absolutely no proof, but I bet more medical mistakes are made by docs than PAs. 😉 Another argument can be made that it’s HARDER to be a PA, than a doctor. One of our professors who is a local PA feels that patients are harder on PAs than the doc. If she makes a mistake on a diagnosis, even if her clinical diagnosis is the EXACT SAME as the doctor she works for would make, the patient is more likely to blame the mistake on the fact that she’s a PA, not an MD. And they will be more likely to give her doc a break, if he’s wrong. Interesting, huh! It would therefore be reasonable to surmise that the pressure is higher on the PA to convince the public that we are worthy of trust and respect as medical providers. That requires more work and dedication to excellence. The fact that we can work in different specialty areas and therefore need to acquire specialty skills when we move to a new area of medicine requires more work, and dedication to learning and excellence, given that doctors do not and cannot switch among specialties. Finally, as I said earlier, we are required to re-certify every six years, something that doctors and Nurse Practitioners are not required to do. Of course you hope your doc is keeping up on all the latest research. But you don’t know if they are going to accurately read your EKG in the clinic, or see that abnormality on your retina because they aren’t required to prove that they are up to date in their skills. So choose your doc wisely!! 🙂 Furthermore, if it’s all about prestige and money, we shouldn’t be in medicine anyway. If I can treat a patient with the same level of skill and discernment as the doc I work for, how exactly is what I do less valuable?
And for the final point, the concern that there are future physicians who don’t see how PAs fit into healthcare. I don’t know where that sentiment originates, perhaps they haven’t worked with PAs, have little experience with them, or knowledge of PA training and therefore make their judgment based on eight years versus 2. What I can say is that it demonstrates that they are out of touch with reality. We all know that healthcare is too expensive, and that there are rampant shortages. Doctors are not the answer; they cost too much money, and because we overload specialists and surgeons with ridiculous pay, many medical school students want to be specialists, rather than primary care practitioners (what our country really needs). So if they think that PAs don’t have a place in healthcare, I’m left to wonder who exactly they think will fill in our enormous gaps in providers. PAs are actually an amazing answer to our country’s needs. They are cost-effective, flexible, and team-oriented. They allow physicians to take care of more people by adding to their practices and clinics. They are often the only providers who will take jobs in rural and inner-city, or low income communities.
So why do I bother to take the time to rant about this on an afternoon where my books are calling my name? Because I wanted to share that four months in, I am more convinced than ever that becoming a PA is the right choice for me. I am so excited about the things I’m learning, and believe strongly in my program. The University of Utah has a great medical school, ranked in the twenties. Our PA program, however, is ranked second in the country, which speaks volumes to the dedication and hard work of those who have developed the program.
So why not med school? You’d have to come up with some good reasons why I SHOULD have spent six more years, hundreds of thousands more dollars I don’t have, etc. etc. in order to do, essentially, the same things.

This term has been sort of the launching into the “meat and potatoes” of our curriculum. In fact, I took my first cardiology exam yesterday. Let’s just say that I should probably understand the heart,. right? I also have courses in therapeutics (drugs), pediatrics, ENT, orthopedics, lab interpretations, surface anatomy, professional issues, physical exam, and I start radiology and something else tomorrow. Like the tagline at the top of my blog- it’s like trying to drink out of a fire hose, it’s crazy. So much to know, but it’s so rewarding. Well, it will be more rewarding when I get to take care of people, but right now, the learning is rewarding to me for all the hard work I put in to get here, and the trust I put in God to go to Grad school.
Finally, I just have to say that I love being here in Utah. Marcus and I are just having the best time! God has provided us with some amazing friends who enjoy spending time with us, great outdoor adventures nearby, and a wonderful faith community that we feel totally plugged into, and challenged by daily in a very good way. We enjoyed our break a few weeks ago- the whirlwind tour through Oregon, Washington and California, and now I’m right back at’em. So no regrets, no “I can’t do this” or “what was I thinking?!” moments (yet-stay tuned,) and no limits to the excitement and joy that I feel regarding my new career.

And no, I’m not hating on docs, it’s just that I’m biased now. 🙂