By COLYN WRIGHT, PA-C
As an adolescent with an illness that required significant travel to receive medical care and receive a diagnosis, I knew from an early age that I wanted to pursue a career in medicine. Oftentimes, I encountered providers who seemed to lack compassion and concern for me as a patient and I knew that this was something I could easily afford my patients. I have always had a special interest in improving access and quality of care in rural Kentucky. From high school, to college, to graduate school I have participated in programs like the University of Kentucky’s Professional Education Preparation Program, joined clubs committed to expanding Kentucky’s Organ Donor Registry, was an AHEC (Area Health Education Center) Scholar. I have served in many patient care settings over the years as I prepared for a career in medicine–as a medical assistant in an urban clinic that provided free healthcare to the uninsured, as a nursing assistant in a critical access hospital, a patient care tech at one of two children’s hospitals in our state, and now as a physician assistant in central Kentucky. One thing has become abundantly clear: Kentucky patients are sick.
While a simple google search confirms it (we are consistently ranked in the bottom 10 of the 50 states in the country), you could tag along with me to the majority of patient encounters to confirm Kentucky’s health status. Why is this? It’s certainly multifaceted.
One thing I love about Kentucky is that we are a stubborn people.
We’ve found rhythms and routines that work from traditions that have been around for generations. Unfortunately, some of those traditions include chewing tobacco, having a beer (or six) after a long day on the farm, adding an extra stick of butter with a heaping tablespoon of salt, and skipping the gym to watch the Wildcats play. By and large, at least in my rural patient encounters, there is a lack of health literacy among patients and unfortunately limited time during an appointment for a provider to intentionally and specifically address the evident lapses in understanding. I can’t express how often I request a medication list from a patient and the response is “just look in the computer” or I inquire as to why they take a certain medication and the response is “I don’t know.”
It’s paradoxical in that sometimes patients blindly trust providers to “do what is right” and often simultaneously are completely cynical of objectively true, well-researched, clinically proven medical advice and trust a random social media post instead. Especially in rural Kentucky, it is difficult because patients are seeking care from so many different healthcare systems. As a result, their lab work, imaging, prior work up, etc. must be faxed over and scanned into each facility because we do not have a universal charting system. In fact, still there are medical facilities where paper charting is mainstream and unfortunately provider’s handwriting is difficult to decipher. It’s hard to say what the best approach is to overcome these obstacles.
The simplest way to fix the problem would be to add more hours to the day so that providers could spend the time necessary to ensure each box was checked from a medical perspective and from an interpersonal perspective. Additionally, it would be nice if patients remembered everything or maybe even 50% of what was said during the appointment. And lastly, an excess of support staff (CMAs, LPNs, RNs, front desk staff, managers) to ensure messages were shared promptly, appointments were scheduled and rescheduled as soon as possible, referrals were processed, etc.
It’s that simple.
Because this isn’t practical or feasible, in the meantime what needs to be done is rather straight forward… we don’t have to complicate it much. We just need to keep showing up. As patients, we must show up for ourselves and truly absorb the medical advice and insight that is shared.
As providers, we must show up even if that means having to bite our tongue, dole out an extra spoonful of grace, or exercise some more patience. It means stepping out of our expert shoes and stepping into our patient’s. It could be as simple as showing up…. Day by day, hour by hour until our impact is felt.
I like to make medicine simple for my patients. I want them to leave an appointment with me like I leave the auto shop. I drive in slowly knowing I have a problem, admittedly oftentimes overdue for my oil change, but not knowing how to fix it. The mechanics take a look at my car, survey what needs to be done, and then send me on my way with clear instructions regarding when to be back and what to do in the meantime. I’m sure you also have a handy dandy windshield sticker. For my patients, sometimes that looks like writing the layman’s terms next to the big scary words so everything makes sense. Oftentimes it looks like making a chart or a checklist that simplifies medication instructions. It sounds like a call to explain when a lab value comes back abnormal. It looks like a scribbled web of possibilities written out on a piece of paper so that they can share the medical plan with family who couldn’t make the appointment.
Other times it means offering a hug as we wrap things up, offering my phone number if a question or concern arises, or simply being a warm smile committed to finding a solution.
A career in healthcare certainly has its challenges but there is joy to be found in the mundane as well. It is a privilege to be the provider who “figures it out” and “makes it make sense” for a patient. I hope I never lose sight of the honor that it is to pull up a chair beside someone as they share some of the most vulnerable parts of their lives and to be an integral part of improving someone’s quality of life.
About the author
Colyn Wright, PA-C is a physician assistant serving patients in central Kentucky. She holds a B.S. in Human Nutrition and Masters of Physician Assistant Studies from the University of Kentucky.