The Transition from PA School to Real-World Medicine


I recall the feelings I experienced as I completed PA school- excited, proud, shocked, relieved and terrified. I wondered how I would handle actually practicing medicine. I knew there were so many things I still did not understand. As I arrived to work on my first day as a physician assistant, I thought about all the mistakes I could make. “Why did someone give me a medical license?” I wondered to myself. There I was in a long white coat, which demanded authority, feeling anything but confident. The first time I entered a patient room, I tried to introduce myself as a PA student, “I mean.. I’m a physician assistant.” The words surprised me. I did not realize how strange they would sound coming out of my mouth. For the first week, I behaved much like a PA student. I asked permission for everything, and I mean everything. You never know if you’re overlooking something major by making a silly decision, right? “Is it okay if I switch this patient from thigh high TED hose to knee high TED hose?” Yes, I actually asked that question. What if it is not as simple as I think and then my patient gets a blood clot, right? “My patient’s INR is 9. Is it okay if I hold his Coumadin?” Yes, I actually asked that too. I was afraid to make big decisions even when I knew they were right.


After questioning myself over and over again about every little thing, I learned that many things that I thought were simple actually were simple and my education was sufficient enough to call myself a physician assistant. Now when I question myself, I discover important details that help my patients. I still look things up every day and use as many resources as I can get my hands on- whether that is nurses, pharmacists, other providers or the good old internet. Now, I’m confident with my orders.


There are many things I’ve learned in practice that I never thought about in school. In school, you learn if a lab value is low, find out why it’s low and make the value within normal limits. In practice, that’s not always the case. I’ve learned to treat complaints that actually bother my patients or endanger their well being and not every abnormal value needs investigated. I’ve learned to be comfortable with a certain degree of abnormal labs. I’ve learned that many people have underlying medical problems that complicate decision making. And in those instances, it’s important to ask questions and do your research. I’ve learned a major crisis can be resolved if you consider basic principles of airway, breathing and circulation. For example, when a pulse ox is 70, consider are they on oxygen? Is their oxygen line kinked? Can we turn up the oxygen? Do they need bipap? The most important thing I learned is when I think I know what to do, it is usually because I do. When I think I don’t know what to do, it’s time to be humble, ask questions and do research. Pausing in these instances makes a difference.


We’re given a medical license because we deserve it. Fear of mistakes is natural. Questioning yourself is good. We have the power, ability and responsibility to change lives for the better.


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