A Q&A with Terry Rand, Cardiac Surgery PA

From time to time, it’s insightful to get a chance to hear what medical professionals have to say about their continuing medical education and the unique paths their careers have taken. We were able to sit down with Theresa Rand, a physician assistant in cardiothoracic/vascular surgery currently in Advanced Practice’s Locum Tenens program, which allows her the flexibility to spend a few months in one city before traveling to a new destination and trying something new. She started her career as a nurse but decided to go back to school to see what other opportunities were there for the taking. We asked her about her educational and career experiences.

What made you decide to pursue a career as a physician assistant?
I was a nurse and had so many “why” questions that no one would answer so I went back to school to find the answers myself.

What sorts of strategies do you use to stay abreast of new medical techniques and procedures?
I receive three journals and have email blasts from my different areas of practice. I get newsletters from: Society of Thoracic Surgeons, Society of Critical Care Medicine, American Academy of Physician Assistants, and Association of Physician Assistants in Cardiovascular Surgery. I also attend several meetings. I have attended hands-on training seminars for invasive procedures including intubations, line placement and endoscopic vein harvest.

Do you learn best in a hands-on environment or through online instruction?
I learn best from being involved. Whether being involved is hands-on (which procedures need to be) or an online course, as long as there is interaction I can learn. For me, interaction could be in the form of questions, a test or animated “hands-on” if live procedures aren’t possible.

What’s been the most challenging part of your job?
In the beginning, it was changing my thought process from a nursing standpoint to a medical standpoint. Now it is more in line with dealing with regulations that make little medical or financial sense. Pairing that with trying to do the best for patients who have no interest in taking care of themselves is very challenging. Those patients have the “somebody else will do it” attitude.

What’s the most rewarding part of your job?
Successfully taking care of someone and they do well as a result. Saving a life!

If you could pursue a new specialization, which field would you choose and why?
It would be transplant surgery. I have done heart and lung transplants and there is nothing more rewarding than seeing someone so sick get better.

What is the most interesting thing you’ve learned about the certification/recertification process?
Overall, I feel like I really learn something new because in my day-to-day routine I don’t deal with most of the topics that are required for the test. Helps me stay on my toes, so to speak, and brings me up to speed on new techniques and technology.

Where do you see continuing education going in the future?
Unless more organizations see the benefit in live instruction and invest in the knowledge of their staff, I see it being more online as time and money play a bigger factor. Hopefully the former wins out!

What is one thing you think will be an important part of a PA’s career moving forward?
It is possible to “out charge” ourselves. As the demand goes up but reimbursement declines, we can cost more than we can bill. That will require us to be more efficient with our daily procedures.

Can you impart any words of wisdom for others deciding how to continue their education in the medical field?
Always be on the lookout for things that will be helpful for you. There are many resources out there for the using, and the industry will thrive if more people demand more learning resources and opportunities. Always keep that excitement of learning something new!   
 
Theresa was a nurse on her hospital’s cardiac floor for three years before going back to school, and she’s been in cardiac surgery for over 20 years. Her daily workload involves taking care of patients in the ICU or critical care unit. She also works regularly in the operating room to harvest veins from the leg and work across from the surgeon assisting in all types of cases that include the chest and blood vessels. She currently resides in Virginia, but her program will have her moving to Wyoming in the new year. We thank Theresa so much for her time and insights!

Ebola and Hospital Safety

Starting in March of this year, the World Health Organization (WHO) reported an outbreak of Ebola in Guinea. News coverage of the virus has been widespread and thorough, and although incidents reported in the United States are minimal and controlled (and news coverage has slowed as of late), this is still a good time to remind our readers of important hospital safety procedures and some facts about Ebola. Dr. Kent Brantly, who himself contracted the virus disease while working in West Africa, spoke back in September to a Senate subcommittee on the necessary precautions every medical practice should take.

In the unlikely case of someone at your hospital being diagnosed with Ebola, one of the most important (and often overlooked) steps is making sure you have all of the necessary referral contact information prepared to alert appropriate local and state health departments. This ensures the appropriate parties are aware of the situation in a quick and efficient manner. It’s also helpful to know contact information for any associated hospital systems to which you refer patients.

Make sure your staff is prepared for such a situation! Everyone should have a role and everyone should know what is expected of them if an Ebola diagnosis comes to light or may come to light as a result of patient symptoms. For example, an administrative assistant in your practice who is scheduling appointments would do well to inquire as to a patient’s travel history and symptoms before admitting them to your offices.

Isolation is important. Designate a space in your practice that does not have frequent foot traffic or use, and utilize that as an isolation room until local or state officials can transport the patient to a more secure facility.

Now that you have your plan in place, what are some personal steps you can take to stay healthy and proactive? What are some common misconceptions about the Ebola virus disease? 

1. Wash your hands! Not only does it make sense from a hygiene standpoint, but it assures that you don’t unintentionally introduce something to your body via your mouth, nose, eyelids, etc.
2. It’s spread only if a patient shows symptoms. If they don’t show symptoms when you were interacting with them, they aren’t contagious. 
3. Wear standard medical equipment whenever possible. If you’d normally conduct a simple exam without gloves, then add gloves to your routine moving forward. Masks and goggles should be used as well if a patient displays known symptoms.
4. Be extra careful with bodily fluids. Double check containers, bags, caps, lids, and more before using them for fluid tests.
5. Let someone know if you feel unnaturally ill. The common cold is no cause for concern, but an unnaturally high fever shouldn’t go untreated.

Resources and further readings on Ebola are vast. The World Health Organization has a very useful section on protective measures for medical staff which you can view here. It details putting on and removing protective equipment as well as taking and shipping blood samples from suspected patients. Doctors Without Borders also details the known history of Ebola and useful information to stay safe and alert as new patient cases are diagnosed and treated. The AAFP has a quick and simple list of precautions you and your practice can use to be fully aware of how to handle a situation regarding Ebola. Widespread infections are highly unlikely, but this is a great opportunity to review your practice’s medical emergency plan and educate yourself on how to properly deal with Ebola.