Monday, March 19, 2007

Points for Grammar

I'll continue my budding rant about excellence vs. mediocrity, which is designed to turn into one about politics, soon. For now, I'm just going to whine about this idea of my career path being "Physician's Assistant."

The focus of my white-hot burning rage isn't the people who innocently use the wrong term. It's not really even the lack of careful thought that would reveal to any sane and intelligent person that if you go to school for eight years to be a doctor, you don't go to school for six years to be some doctor's "assistant." No, the problem I have is with the general fatigue we all seem to have suffered, which makes it all the easier to shrug our shoulders and be wrong about stuff without caring.

Oh, look, I guess this is the rant about mediocrity. Cool.

I'm going to keep politely correcting people. Accent on politely. I won't be deeply and personally offended, I won't hold it against you if you do it, and I'm not going to go out of my way to interrupt the flow of conversation to back up and fix the mistake. But I'm also not going to let it slide, if it can be helped.

Not for reasons of ego; if my ego were really that sensitive, I'd probably think it was worth it to do the time and get an MD. More because Judas Priest, people, the profession has been around since the 1970's, and the AAPA has somehow done such a horrible job of publicizing it that it falls to those of us who will actually be, you know, doing it to explain what it even is.

My job right now, the one where I work in the Emergency Department and get paid less than I did in 1998 as an office temp, that's an "assistant" job. I'm a nursing assistant, I'm a medical assistant, whatever you want to call it. In Ye Olde Days, I would have been called an "orderly." Which is kind of a cool title, because it reflects my function well. The ER gets disorderly in a hurry, and I help fight back the forces of entropy. Yes, I wipe some butts (although thank god I don't work in a nursing home). I push stretchers around to xray and up to the inpatient floors. I fetch stuff, I clean stuff, I stock things so they are there when clinical people need them. I generally make other people's jobs easier. And yeah, I get to do some cool stuff as well.

So I am the assistant to the nurses and to the physicians. Gramatically, I am right now a "Nurse's Assistant," and I am a "Physician's Assistant." (Okay, really I'm a "physicians' assistant," but go with me here.) I would never call myself that, because it would just make the confusion worse, but the point is the butt-wiping stretcher-pusher is the apostrophe-S assistant. The PA is somebody that sees patients and practices medicine.

The word "Assistant" is built right in to "Physician Assistant," so it's a logical and reasonable thing, if you're encountering the phrase for the first time, to assume there's a fair bit of assisting going on. "So do you pass instruments to the surgeon, and close up at the end of the surgery?" "That's like a resident, right?" Arrrrgh! But as I say, I can't get too wound up about it. It makes sense to think that.

After all, executive assistants are there to assist executives. Production assistants run around film sets, assisting people with random stuff that has to do with production. And physician assitants... practice medicine. Great. Thanks. Awesome.

In a nutshell, we "assist" physicians in kinda-sorta the same way a law firm's junior associates "assist" the senior partners. We do essentially the same job; true, the major cases and the really uber-high-stakes stuff will tend to go to the higher-ups, but that's fine because more training and more experience means you should handle more pressure. By handling a chunk of the cases ourselves, including mostly the stuff that comes in every day, with a little fun stuff mixed in, we reduce the workload. That's a mighty fine way to assist.

How awesome would it be if you had someone at your job who did the same thing you do (at a level a little under yours), and all you had to do was answer the occasional question or give some advice? This person does, let's say, 40% of your total work, and they do it as well as you do. Would you call that person your assistant?

Yeah, it's confusing, and yeah, it's vaguely insulting that the wrong idea persists. I saw a PA recently at the Target Clinic, for removal of some stitches, and as we were talking, I remarked that the poster outside in the little waiting area had an apostrohpe-S. She said "yeah, you kind of have to get used to constant little insults." Ohh, yay.

So if I've explained this to you already, sorry to be repetitive. I'd love to stop having to be.


Cybele said...

The thing that's done in my neighborhood is people who do what you do are called 'PAs' and the other sort is the physician's assistant, with no capitalization.

At least, that's common practice for those of us who are literate.

Febrifuge said...

But people who do what I do aren't PAs. I'm a tech; I literally assist other people in doing their jobs. I hold kids so nurses can start IVs; I cut people's clothes off and hook them up to monitors. I have no real clinical responsibilities of my own, and no decisions to make except which important but non-urgent task to complete next.

I'm afraid you might be proving my point... "PA" shouldn't be used as a job title, except to mean Physician Assistant. Particularly in a hospital.

It's just too confusing. Were you meaning my future job, or my current one?

je said...

Maybe P.A. should stand for Physician Associate, to continue the law firm analogy. Or paraphysician? Maybe that's more like a nurse. But it's badass because it sounds like paratrooper.

Many people think that I am a "legal aide." And by people I mean my clients.