7. What you write down is permanent. If you don’t write it down, it didn’t happen. The medical record, whether written or electronic, is a legal document, a means of communication between providers and often an invaluable memory aid. I review medical record notes daily, some written by myself, others by my supervising physician or other providers, to learn about a patient’s history and physical exam findings. If the notes are illegible or incomplete, then my knowledge is incomplete. No one can recall every patient or the details of every patient encounter. Patients often see multiple providers and frequently move between providers and settings, making the medical record more vital than ever to continuity of care and prevention of errors.
8. Don’t worry about learning all the drugs—they’ll change. Boy, is this one true. I can think of only a handful of drugs that I learned about in school that are still used in the same dosages for the same conditions (for example, digoxin, furosemide, hydrochlorothiazide). Some drugs that had fallen out of favor have actually been found to be beneficial and are now back in use (spironolactone and hydralazine for heart failure, oral hypoglycemics for type 2 diabetes). Other classes of drugs didn’t even exist when I was in school (antiretrovirals, SSRIs, ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers, to name a few). Pharmaceutical therapeutics has gotten much more complicated, with dozens of new drugs approved annually by the FDA—not to mention all the medications that are now OTC and all the vitamins and supplements that people take.
9. It takes a team to deliver health care. Work with others; use their talents and expertise. In the 1970s, the word “team” in medicine was considered radical. Now, health care administrators, planners, and systems analysts all talk about teams as the way to improve care in every setting. There are stroke teams, cardiac bypass teams, home care teams. It was integral to my PA training to learn to work with others. These skills have continued to serve PAs well as team care has become the norm.
10. Medical knowledge is ever-changing. Keeping up with changes in our ever-evolving health care system requires dedication. Learning how to review and synthesize complex information and deciding which sources (journals, Web sites) are valid and relevant to one’s work are essential skills. They were integral to my early training, and they are just as important today to keeping my practice current.
Thinking back to my early years in the Johns Hopkins program, I remember the multidisciplinary faculty of physicians, PAs, basic scientists, pharmacists, and social scientists. We were videotaped regularly and had a required assignment as patient advocates in the emergency room. We studied art and literature as it related to health, along with microbiology and pharmacology. In the ensuing years, a significant number of graduates, like me, have pursued additional education and training, going on to earn doctorate degrees in various fields.
It was an intense two years that I recall fondly and that has definitely served me well. The faculty were visionaries and wonderful mentors. I hope those of you in training today will be able to say the same in the decades to come and that the fundamental truths I have listed here will help guide you in your journey.
Freddi I. Segal-Gidan is Director of the Alzheimer’s Research Center of California at the Rancho Los Amigos Medical Center in Downey, California, and Assistant Clinical Professor at the University of Southern California Keck School of Medicine in Los Angeles. She is a member of the Clinician Reviews editorial board.