Every day people put their full trust into their doctors to save their lives and keep them healthy. The years of schooling and amount of money for schooling gives people a sense of safety. My research was based on exploring the option of becoming a Physician’s Assistant (PA). I wanted to go to medical school and become a doctor, but recently the option of becoming a PA has interested me. The importance of the role of the PA has become vital in recent medical research. Growing up, I was surrounded by science and medicine. My mother and sister are both registered nurses and I’ve heard the stories they’ve been telling since I was young about the amount of grueling hands-on work that they do while their doctors barely ever see patients or do the work that people think they do. In my personal experience with doctor encounters, I have been given many great things, but a couple detriments. I am anemic. This means I have a deficiency of red blood cells or hemoglobin. I would have to go to the hospital every month or so to get transfusions and iron. Since it was so often, I built a strong relationship with my health-care professionals. Out of all the times that I went to the hospital, I only met my actual doctor a handful of times. Every other appointment I was accompanied by a PA and nurse. On a less serious note, I also went to a dermatologist for that pesky teenage acne. And even at this very fancy dermatologist that I went to every month for a year, I only met my doctor once. Seeing this lack of relationship first hand always intrigued me.  For me, the most important aspect of my career is helping others. I want the hands-on action of getting to know my patients and truly caring for their health. A good doctor consists of skills, interpersonal relationships, and trust. 

The importance of this essay may be disguised to the everyday person, but it is applicable to all. My research isn’t just about doctors and PAs, it focuses in on the patient relationship to include them and their importance within the medical field. Todd Buchholz wrote that there will be a large shortage of doctors by 2025 of up to 90,000 in the U.S. This frightening prediction shows the increasing high demand for the position and need for the supply side of this issue that doctors and PAs can fill. Though this is a medical essay, it fully includes everyone from the civilian to the doctor because these issues affect all. For the civilian, it’s about the want and need for more trustworthy relationships with the people that we put our lives in the hands of. And for the doctors and PAs, it’s about being able to have fantastic medical skills, but also build the skill of being a person for patients to fully depend on and be happy to share their story with. Both aspects of this are embedded in the patient-doctor relationship and both sides depend on this for a healthy and happy solution. 

In the article “What’s a good doctor? And how can you make one?”, Hurwitz inserts that “medical education today should be aiming to marry the skills and sensitivities of the applied scientist to the reflective capabilities of the medical humanist.” This idea explains that some doctors have one of these sides and not the other, which can be a dangerous misconception of what makes a good doctor. Some may have inadequate skills or inconsistent values, but good intentions, making them a poor doctor. On the other hand, a good doctor is one that “combines individual clinical expertise and best available external evidence.” This broad statement equates to individuals that are thoughtful and evidence-based doctors. Fiona Stevenson writes, “If concordance is to be achieved then it is necessary for both patients and practitioners to disclose and discuss their concerns and views.” All of the facts about the patient are vital to correct diagnosis, but not only is the patient’s life important, the doctor’s is as well in order to keep the patient’s values in line. “In order to encourage patients to feel comfortable in this task, practitioners need to listen carefully and empathetically,” this shows the need for these personal traits in the doctor-patient relationship (Stevenson). 

When it comes to the patients, their main needs are the technical skills that we expect from a licensed MD, but also the interpersonal relation. In fact, the aspect of care and humaneness came before the doctor’s actual competence (Hurwitz). In the British Medical Journal, Coulter wrote, “failures in communication and incorrect assumptions about patients’ preferences are surprisingly common,” which is a shocking observation for some. These seem like obvious maltreatments of patients, yet they are described as surprisingly common. Priorities in health-care are another issue in the doctor-patient relationship. In a poll from the Netherlands, which is one of the most forward medical thinking countries in the world, patients put their care in consultation time, appointment availability, and detailed information about their illness while doctors prioritized care coordination, home visits, and continuity. This gap of priorities causes a gap in trust and patient review. This shows the want of patients to be informed and a part of the process while doctors want a long term relationship with their patient which often means they want an unknowing and calm patient. In an article from The British Medical Journal, Coulter says that patient groups have been drawing attention to the traditional medical way to “demean and disempower patients” (Coulter). Patients want to emphasize self-education in the medical model (Coulter). In a book by Howard Waitzkin, he describes the barriers of communication between patients and doctors. These barriers include race, sex, age, education, and other background details about each person. He connects that, “a patient’s experience of physical problems is inseparable from the wider social context in which these problems occur.” He then goes on to explain this by saying that “pain and pathology afflict more than the body.” The interesting fact that Waitzkin was on both the patient and doctor side sheds light on the trouble for each party. A patient’s physical sickness is never just an illness, it can be fully affected by their personal life and relationships. I think this is a cool point to make when talking about the importance of the relationship because it isn’t just for feelings, it’s for the medical means as well. 

One key issue with the doctor-patient relationship is trust. In a TEDMED talk called “What your doctor won’t disclose,” Leana Wen, a licensed doctor, explains many doctors secret, behind-the-scenes agendas. Being a doctor, she has first-hand experience witnessing the deals that doctors make with many drug companies. These relationships are more often than not never shared with patients, even when they are being prescribed drugs from these affiliated companies. This puts a large question into many patient’s minds because it turns a patients need into a money scheme, obviously making patients uncomfortable and doctors credibility questionable. Patients and hospitals also put a lot of trust into a very simple fact: where the doctor went to medical school. In an article called “Rethinking the Way We Rank Medical Schools,” doctor Pauline Chen says, “the notion that a medical school’s quality can be ranked and then passed on directly to their graduates has become an integral part of American culture.” This illuminates America’s blind tendencies to assume an individual is as good as the whole without hesitation. She goes on to say, “…most of these popular rankings reflect a school’s highly specialized research funding and capabilities, not the general quality of its medical school graduates,” though these are important, they really only display the history of that school and not the new students (Chen).  

In a study about implementing physician’s assistants, a brief solution is brought to the table. In this study, patients were asked to rate their patient care from both their doctor and their physician’s assistant (Timmermans). Patient evaluations were significantly highest for PAs as a result. I believe this is because PAs are able to have a specific focus and have more time to build the personal relationship with patients that doctors simply do not. Buccholz also inserts, “state governments should give greater authority to nurse practitioners and physician assistants to open their own practices and encourage walk-in clinics.” This implementation could help the need for doctors and the wait for appointment times. Though PAs are a logical solution to helping the interpersonal relationship with patients, I believe it is wrong to simply say choose a PA over a MD. MDs go through long and expensive schooling and deserve their title immensely. I do not want to discount for their hard work and dedication to their job. In the book, “The Politics of Medical Encounters,” Waitzkin explains that, “medicine sometimes, but only rarely, involves a straightforward technical solution to a simple technical problem.” I find this an interesting point when comparing PAs and MDs because it shows how difficult diagnosing is and the intense thought that has to go into each individual account. There is a reason MDs cannot give the relationship with their patients as well as PAs can and it’s because they do so much in a day. They quite literally don’t have time to make this deep connection with each patient. PAs are very specialized and stay in one section of the hospital usually and see their patients every day, over and over again while doctors roam the entire hospital and see so many unique cases daily. Not to mention the research they can be involved with as well. Though I lean towards becoming a PA for the reason of having those relationships, I think it would be ignorant of me to assume it is a better job and that MDs aren’t doing enough. It is simply just a different type of job that entails different skills.

The need for doctors is increasing, but the need for good doctors has been in need for years. The main part that gives a doctor a good title is their ability to diagnose and provide treatment. But there is another side that is just as important even though it is not something that can just be taught. The importance of the patient-doctor relationship is so great that it comes before skill in some patient’s eyes. The need and want to be informed and to be a true part of the medical process is growing exponentially. Since there’s been a change from having your family physician in town to having minute clinics, the interpersonal relationship has shifted into an informal one. For many people this is a sad shift even though our options for health-care have been multiplying. This relationship is based on both the doctor and the patient being fully honest and disclosing all parts to the issue and the solution. Now that the role of PAs has been implemented in the medical equation more as the job itself has been growing, research has come out about their success. They have been ranked higher in patient care in general, but also when put up against doctors. Though I believe PAs should be incorporated into the medical equation more, there are still reasons why doctors cannot give what PAs can. PAs are specialized in specific areas of the medical field while doctors can be more generalized making their patient-doctor relationship less intimate. Since doctors have such full schedules, they have to get around to many unique patients while PAs will stay in an area with their patients personally all day. My research has showed me that my interest in my medical career will lean more towards the physician’s assistant side of this argument. Since I enjoy and cherish the relationship built with individual patients, my decision was almost made for me after this research. There are many other aspects of the job that interest me as well, but this is one of the most important for me. And quite honestly, if I can get that for less money and less time, I will. 
