Dear Future Me…

Marisa-banner-newClinical rotations in PA school are all about learning. You see patients with conditions and diseases that you have read about during didactic year and learn how to manage them in the “real world.” You become more familiar with the inner workings of various clinical settings: emergency departments, operating rooms, outpatient clinics and inpatient wards. You learn just enough about insurance, billing and coding to make you teeter on the edge of sanity and be thankful that there are wonderful, capable people who manage those areas of clinical practice so it doesn’t fall on you to count bullets or verify ICD-10 codes for each diagnosis you make (though they can be amusing to peruse…my favorite? W61.62XD “Struck by a duck, subsequent encounter”). You master (well, try to master) the nuances of different electronic medical records and are amazed at how much easier holistic healthcare can be when all patient records are available for you to see.

The thing is, you end up learning about way more than just medicine. You learn about yourself and the kind of provider you want to become. You leave your comfort zone and embark on a 13 month adventure that takes you to clinics and hospitals throughout the Pacific Northwest. This journey has you living with classmates, honing your physical exam skills in urban and rural communities and meeting countless mentors, preceptors and patients. Along the way, you absorb all that you see and experience. Some of it you internalize, adding it to your ever-growing clinical practice toolbox. And some of it a bad attitude, a confusing explanation, things that just don’t fit who you are are thoughtfully discarded. Through this process, we begin shaping who we ultimately will become as healthcare providers.

So, my dear Future Me, after sorting through what I have seen and the experiences I have had on my clinical rotations (so far!), these are some things I hope you will remember:

  • Your patients are mothers and fathers, brothers and sisters, children and grandchildren. Each of them is a person with a story that you will most likely never know if you just treat a condition or disease. So get to know them. You won’t regret it. Most will appreciate the opportunity to tell you about their new grandbaby, new job or even their hardships. Understanding the psychosocial circumstances of a patient can be invaluable and may help explain lack of compliance or provide context for their health goals and concerns (or apparent lack thereof).
  • Stay patient. (No pun intended!) Even when you are running behind schedule or computers are down. Even when you have to repeat yourself or your patient asks you about “one more thing” as you are heading out the exam room door. Even when patients are upset that you won’t prescribe antibiotics for a VIRAL infection. And especially when an honest mistake is made…you were once a learner too.
  • Listen. Really listen. And ask questions. 90% of the diagnosis really does come from the information you gather by talking with your patient.
  • Take care of yourself. You are much better able to care for your patients if you are well rested, well fed, well socialized and well exercised (evidence: your second rotation).
  • Patients have free will and you can only do so much. Patients are ultimately the decision maker when it comes to their health, and they have a right to disagree with you or not comply with your recommendations. It is not a personal failure when you have done what is in your power to help them understand your concerns for their health, and they end up not heeding your advice and/or experiencing adverse consequences. Recall the sage proverb: You can lead a horse to water, but you can’t make it drink.
  • Don’t buy into an organizational hierarchy. Healthcare is a team sport and you need countless people, MAs, administrative staff, nurses, janitors and everyone in-between to provide quality care. And don’t forget to express your appreciation. A genuine “Good job!” or “Thank you!” is priceless.

Most importantly, please always remember the excitement and passion that led you to and got you through PA school. Don’t become a provider who can’t wait for the day to be over…who views their days in clinic as something to “get through.” Find a group of providers that are as excited to go to work each day and who care for their patients as much as you do. Join them. And enjoy every day that you get to practice medicine. 

2 responses to “Dear Future Me…

  1. Very insightful Marisa!

    I have an upcoming interview for the PA program at OHSU and wanted to ask you a few questions based on your post…

    How close/far are clinical rotations from the campus. Is a vehicle needed for most? Are the majority of rotations in rural/underserved communities or do many assignments occur within OHSU facilities?

    P.S. I work as a scribe at an urgent care clinic and we all got a kick out of the “struck by duck” Dx code. 🙂


  2. Such good advice, Marisa! I wish I had written a letter to the “Future Me” as I know my perspective changed tremendously from student to professional status – and not always for the better. this is a good reminder to stay true to yourself and the patient’s best care.

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