We have all been glued to our seats when not working, to keep tabs on the COVID-19 virus which has become pandemic. Our lives have changed in the blink of an eye and we have discovered what it is to be living in a time when exposure can mean death and the soldiers are healthcare providers. President Trump has called this “The Invisible War.” As I write this short article, I am directing my focus on the invisible soldier in this war, the PA. The PA profession has a history of being unrecognized by layman. We have gone on for the past fifty years camouflaged in spite of the work that we accomplish. We are not recognized for the profession that we are and as I listen to the President, the CDC, the Admiral of USPHS, the other scientists and physicians and administrators from the White House, I have yet to hear the title of PA. Why are we not mentioned? Are we invisible? Apparently. Iowa PAs have been petitioning their state legislature unrelentingly and as I went to bed last night, the following post was made online:
DES MOINES, Iowa —
Gov. Kim Reynolds announced Wednesday that she signed a bill allowing for physician assistants to expand their services.
“Enabling physician assistants to better serve the health care needs of Iowans will result in better care in a timelier fashion,” said Reynolds. “As the state continues to combat the spread of COVID-19 and the strains it will place on our health care system, this will be yet another tool in our arsenal.” This gives physician assistants expanded prescription rights. It also gives them more legal protection in doing so and the ability to be reimbursed by Medicaid as well as other changes. These are the results of proactive legislation.
PAs and NPs, who have also not been mentioned as a profession, need to be proactive because our lives and the lives of our families are on the line. Every time a PA examines a patient in their office, the emergency room, or in the urgent care clinic, they expose themselves to infection. As a soldier in a war zone, I had my weapons and I had the necessary equipment to care for my fellow soldiers. The same applies to every corpsman and their ability to care for their fellow grunts. Yet, in this war against the invisible enemy, too many of us do not have the necessary supplies; we do not have the proper masks, gloves, suits or therapeutics and diagnostic equipment to serve the citizens of the United States. Well over 10,000 healthcare providers have been infected and a thousands more have been quarantined due to exposure. But who are they? America does not know. And what is expected of them? And who can they enlist in the fight for recognition?
I will answer the second question first. We can and do get support from our national organization, the AAPA. This is a renewed opportunity to support the profession and to “announce” us to the broader news media. They have been steadfast during this time of international pandemic to reach out and demonstrate their capabilities, advocacy and support of those qualities which define us as PA’s. We need to have the White House Administration, all of the speakers, our elected officials as well as the admiral from the USPHS acknowledge our contribution. We need to ask the White House PAs who care for the president and vice president to whisper in their ear. We need to ask our governors and emergency room directors for a Shout Out. This is our time!
What are we expected to do? We are expected to leave our spouses, children and perhaps our parents to engage in hand-to-hand combat with COVID-19. Our risks are almost incalculable due to the number of patients being triaged and cared for, not to mention the stressful clinical environments in which we serve. We are forced to work beyond our capacity at times. We recognize that 4 in 100,000 ER visits result in medical malpractice allegations. An analysis of 1,300 of these malpractice suits helps to provide some insight: Care in the ER is episodic and fragmented, especially the diagnostic process which involves communication and cooperation among other professionals and specifically when dealing with a crisis. 47% of these cases in the ER are for failure to diagnose. 39% of ER visits in this group are judgement errors relating to ordering a test or an image. These situations require strong judgement and excellent clinical skills – but this invisible war has an invisible diagnosis, exacerbated by broad-ranging common symptoms which present a very challenging dilemma.
Among things invisible which are required, is malpractice insurance. These are dangerous times for the patient, the care providers and for PAs and NPs who are on the frontlines of treatment. Could we make one of the errors listed above? Most certainly. While we are valiantly doing everything in our power to save lives, so will a plaintiff stand ready to litigate – regardless of the current healthcare crisis and landscape. As this pandemic passes, there will undoubtedly be many lawsuits directed back to these critical months of care. We are not only talking about Coronavirus but ALL medical care in general. We are health care professionals. But we are also individuals who must process these new uncertainties and realities just like everyone else. We are managing our stress on the front lines where sadly, the enemy is within the gates. Why compound our anxiety with concerns about litigation? If we own our own professional liability insurance policy that has been vetted for its strength and quality and endorsed by many professional associations, we need not be fearful. My national association, AAPA, has endorsed a policy, and although I hope never to endanger a patient, I am comforted that the full power of CM&F’s malpractice policy is standing beside me. With unsurpassed financial strength ratings of A++ (A.M. Best) and AA+ (Standard & Poor’s), this is the highest quality PA malpractice insurance available. My future is in good hands with CM&F.
By Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
PA Advisor to CM&F