Prior to PA school, I primarily worked as a pathology technician performing gross dissections (in the macroscopic sense, but often in the literal sense too) of human tissue in Anatomic Pathology. I could slice my way through gallbladders like it was nobody’s business, releasing that sludgy green-brown material known as bile that lets french fries, cheese and everything sacred exist in my diet. I could describe every minute detail of a perforated appendix on my pathology reports, forming a word-picture vivid enough that my supervising pathologist would rarely have to re-examine my work. I was GOOD at my job – and then I came to PA school.
OHSU’s 2000-hour direct patient care requirement, the equivalent of 12 months of full-time work, was daunting to a lab rat like me. I felt like I was constantly counting down from 2000 to satisfy the pre-req. During this summer quarter, most members of our class awkwardly clutched oto-/naso-/opthalmoscopes because very few of us had ever used the equipment before. Where I first felt a divide with my lab background was when we learned how to take a history of present illness. My classmates who were EMTs, paramedics, MAs, ER scribes and CNAs seemed to have the medical interview roll off of the tips of their tongues. By far, exploring the seven dimensions of an HPI has been the most challenging aspect for me as a PA student. In the lab my “patients” were tissue and had I started talking to them, it would’ve been a clear sign that I had enough formalin exposure for the day.
Jump ahead to fall quarter and our clinical medicine coursework is now in full swing. Week after week we’re required to know a different laundry list of illnesses accompanied by their etiology, signs & symptoms, diagnostic work-up, treatment and patient education. I was glad to have the clin med courses “distract” me from my so-so medical interviewing. Each Friday morning exam rolls around, our classmates on the morale committee blast the Top Gun theme song, “Eye of the Tiger,” or some other pump-up music that belongs on Barney Stinson’s “Get Psyched” mix CD, and we test together. I’m not saying that we take group exams, but the environment somehow feels like all 43 of us are rooting for each other and not just ourselves.
During one particular week, our exam tested us on diarrhea and urinary tract infections in depths that I never cared to know. Fried rice and cottage cheese? Yup, both are dead to me now – but I digress. After that exam, I hopped into my car and drove to my Urgent Care preceptorship. My PA mentor pulled the next chart on deck and read: “chief complaint: It burns when I pee.” He asked if I wanted to fly solo for the H&P and after a week of hammering UTIs into my brain, I couldn’t have asked for better timing. I entered the exam room by myself and a photographic image of my UTI study table flashed at the front of my brain. I asked about symptoms, ruled items on my differential in and out, explained the urine dipstick results, and performed a problem-oriented abdominal exam. For the first time in 16 weeks that we’ve been in school, I felt like I was having an actual conversation with my patient regarding their health and was confident about my interviewing skills. However small it may seem to the seasoned provider, it truly was a proud moment of mine and I felt like I could have diagnostically tackled every patient that day…as long they had some sort of UTI.
As a future PA, I want to give people quality medical care and I want to be great at it. It’s the core reason why I chose to become a Physician Assistant. But at this point in time, I have to accept the fact that I may not even be good at it. At least not yet, or on the first try. A year ago to the day, I received that life changing phone call with an offer to attend Oregon Health & Science University. The transition of being an “expert” in the pathology lab a year ago to a student was, and still is, nothing short of frustrating. But over the past 16 weeks, I’ve learned so much from my professors and possibly more from my classmates. The juxtaposition of how much we do know and how much we still don’t know is quite incredible. We study together, we test together, we happy-hour together. At some point in the program, the work experience clock resets for all of us and it’s an even playing field. After all, didactic year is 12 months of challenging full-time work. So here we are again: T-minus 2000 hours, until clinical year.