'Dear Abby' Disses Physician Assistants

The 'Dear Abby' column is well known and loved for dishing out matronly advice on issues from household problems to relationship strife. Columns like "Neighbor's Baby Cries Constantly", and "Old Friend's Schedule Leaves No Time to Catch Up" are bound to stir up a few sensitive souls, but are overall neutral in tone. This week, however, 'Abby' has stepped on the toes of one sector of the healthcare community and is feeling the aftereffects of her comments about physician assistants. 

On July 8th, 2016, in an article titled "Wife Questions Care Received at Out-of-Town Walk-In Clinic", an inquirer asked 'Dear Abby' this question: 

DEAR ABBY: On a recent trip out of state, my husband became ill. The hotel we stayed in referred us to a nearby urgent care walk-in clinic.

The nurse took his blood pressure, which was very high. The "doctor" never took his temperature or mentioned the high blood pressure to us. He prescribed six drugs and we went on our way. My husband was happy; I was not.

When we returned home, I looked up the doctor's name on the internet. Actually, he was a physician's assistant, not a medical doctor. Abby, what should people do if they become sick while traveling? -- TRAVELING MEDICAL EMERGENCY

Abby's reply was this:

DEAR T.M.E.: You have asked an excellent question, one that may help many other people.

It is always wise when you travel to bring along a list of any medications you're taking and a copy of your medical records. Medical records are online these days and can be emailed to you upon request. A lot of health insurance companies offer a 24-hour service to call for a referral to a physician in whatever locale you happen to be.

Physician assistants are standard in many areas of the country as long as they are supervised by a physician -- and in your husband's case, there should have been an M.D. on the premises. You, as the consumer, have a right to ask questions. It would not have been out of line to inquire about the certification of the person who was treating your husband, or to ask to see the supervising M.D.

If the medical emergency is dire, take no chances and call 911. If someone is really sick (having chest pains, muscle weakness, trouble speaking), an emergency room is better than an urgent care because more expertise and testing are available onsite.

Clearly, Jeanne Phillips, the woman behind the Abby pen name neglected to do her background research before drafting her reply. The response contains several inaccuracies about physician assistants. PAs, for example, are not required to practice with a physician on-site in most states. While patients certainly have the right to be treated by whatever kind of provider they like, 'Abby' is incorrect in her assertion that there should have been an M.D. on the premises during the patient interaction.

As a further knock to PAs, 'Abby' neglects to address the fact that dissatisfaction with care can occur in any patient interaction, regardless of the provider's credentials. It seems like the inquirer in this circumstance did not receive adequate discharge and follow-up instructions. While there is room for the physician assistant to improve in this instance, the same type of miscommunication occurs in healthcare facilities among MDs, PAs, and NPs alike. 'Abby's' message should have been more along the lines of helping patients seek the highest quality providers possible in urgent and emergent situations. 

Dear Abby's erroneous reply does a disservice to physician assistants by spreading false information about supervision requirements. It demonstrates a lack of understanding of the PA role, and serves to reinforce this among similarly uninformed readers. Furthermore, the article implies that physician assistants provide substandard care, an unfounded claim.

While one can appreciate that 'Abby' has limited space to address complex questions, there is no excuse for publishing false information. The American Academy of Physician Assistants says they have reached out to publishers of the 'Dear Abby' column, and "will continue to monitor the situation and will provide updates as they have them". 

What do you think about Dear Abby's comments regarding physician assistants?

 

You Might Also Like: PA vs. MD Salaries - A State-by-State Comparison

 

Comments

She did not diss PAs. The requirement for billing and this is for both Medicare and Medicaid whether it's a PA that someone is seeing or an NP is that the attending physician has to be billed for the services rendered. And if something does happen to the person as a result of the care from the PAs or NPs and suits occur the attending physicians would be sued.

The advice given in the column was correct.

Kristy

In this entire scenario, the only true problem I can see is that Dear Abby misinformed her readers about PA supervision. Unfortunately, she has millions of readers.

There is nothing to back up the wife's claim that the blood pressure was "very high" (show me the numbers). There is no reason to infer that the PA did not provide adequate discharge and follow-up instructions, nor is there reason to infer that the PA did not perform well for that matter. We have a fairly vague description of one side of the story from a dissatisfied customer- who wasn't even the patient. As long as we are talking about what Abby "should have said" I say she should have said Dear Patient's Wife, take some personal responsibility. When you have a concern, speak up about it. Ask questions, get answers. Don't be passive aggressive and send anonymous letters to advice columnists whose educational credentials include majoring in English, and anthropology. Did you really go back to your hotel room thinking you would just wait and see if your husband survived that "very high" blood pressure, not realizing you could take him to an emergency room for help. Do you really not know what to do if you become ill when you are out-of-town? Maybe you should stay home. Where it is safe.

Lisa A Johnson

I was offended by her disrepect for PAs and NPs. She needs an education and a lot of protest letters!

Nancy

This article and the actions of the AAPA should not berate a columnist because she is not versed in the rules and regulation of PAs. A better answer would have been did you contact your primary care physician prior to seeking assistance at an urgent care? Did you contact that PCP after the urgent care visit? Upon return from vacation did your husband follow up with his PCP? There are many ways to better handle this situation including requesting the columnist to retract her answer citing her ignorance about the scope of practice of PAs.

Ellen

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