Before I became a PA, I used my Master’s degree in Psychology to work with the severely mentally ill. During this time, I learned that everyone has a story to tell.
While training in PA school at Saint Louis University, one of my instructors told our class that the most crucial part of an appointment is taking an accurate history and knowing what questions to ask. After this, you need to allow the patient to talk, because they will often give you the diagnosis.
Throughout my 10 years as a PA, I have used the skills I acquired in these two learning environments to encourage my patients to tell their story and chronicle the events that led up up their appointment.
During their story, I only interrupt at a minimum to verify my understanding while collecting pertinent details. When the story concludes, I typically only ask a few additional questions to fine tune an accurate history.
If I don’t have a diagnosis by this point, I’ve at least narrowed down to a handful of possibilities before conducting the physical exam and ordering labs, imaging and office procedures.
Make no mistake, I realize that listening is a skill that takes time, patience and practice to hone. As the provider, you must train yourself to quiet your thoughts and remain in the moment with the patient. Remember those seemingly insignificant details, because you often must make inferences and deductions. Lastly, you need to listen to what they are not saying.
This process takes a little longer than other methods. However, the clear benefit is that fewer delays are encountered while developing an accurate diagnosis. The end result is that the provider initiates an effective and appropriate treatment more quickly, which leads to better outcomes for the patient.
– KIM BREY, PA-C
It has been a long time since I wrote in my blog. The holiday season is very busy for surgeons (having met their deductible, many people try to have surgery before the end of the year), and then the time just got away from me. I started this entry right before Thanksgiving.
As a Christian, my life is dedicated to trying to bring glory to God in any little way that I can. Now, I often fail, but it’s a striving and a focus that informs my day to day living. I don’t think that we have a “spiritual life” and a separate “secular life”. I think it is all integrated. As such, when I come into an exam room or the operating room, I am thinking “What is God doing here? How can I join in with His work?” Sometimes it is as simple as giving her an antibiotic, other times it is praying about a struggle in her life, or praying that the surgery and recovery go well, and using my surgical skills to help her.
I used to pray with every patient before surgery and take a spiritual history on every patient, but that began to seem a little too rote and forced. Now I follow the leading of the Spirit. When I feel that I need to pray or ask probing questions, I do it. It is amazing how God answers, often in ways I didn’t expect. Just the other day, I prayed with a patient who had just found out she had rectal cancer. I could see that she needed the comfort of knowing that God will be with her in her fight.
Patients are often surprised to have their doctor pray with and for them. Sometimes I feel a little silly praying for a what is for me a simple routine bladder lift; I mean, it’s not brain surgery or heart surgery. But then again, for the patient, there is nothing simple or routine about it. I typically pray for the surgery to go well, for the entire OR team, for the patient to be healed and to recover well, and for her to have peace as she goes into surgery. Most patients are very grateful for the prayer. Occasionally I can see that someone feels uncomfortable, so I try to be sensitive to that before I pray.
I have some examples that show how God has answered prayers in my practice and in my life. One day the robot at the hospital broke down before my case. That was just one of many things that had happened that day. There were odd delays and unexpected events that occurred. Everyone did great and no one was harmed by any of the issues. But it was really stressful on me, because things weren’t going smoothly. I just continued to lean on the Lord and pray for my patients and for our whole surgical team. One of my patients told me that she was shocked when I prayed for her, but she told me that a sense of peace filled her heart and any nervousness that she had was gone. Her surgical procedure was changed at the last minute due to the equipment malfunction so there was a lot of anxiety for her. But the Lord gave her amazing peace. She is now several weeks postop and doing great.
Another example was a stone case. I had been covering this patient in prayer for a few days prior to the surgery date due to her underlying health issues and the size of her stone. This case went from a simple laser case to an open bladder case because the stone was bigger and harder than anticipated. I was also concerned because I thought the bladder had partially ruptured when I was using the laser. When I realized that I had to open her up, I called my office to let them know that I would be running late for my other patients due to the change in the plan. I didn’t know it at the time, but my staff then all took a moment to join hands and pray for our patient. Well, the open surgery went about 500% better than I had expected: there was no rupture, the bladder was not as malformed as I thought it might be given her underlying disease, and the stone popped right out (it was about a 4 inch stone). Another answered prayer! She recovered beautifully and is doing better than ever.
Not only do I pray for my patients, but my staff does, too. We all get to participate in what God is doing. He cares about every part of our lives, even our urological health!
I have always been so thankful for the privilege of being a doctor and specifically a female urologist. I hope that God is honored in my service to my patients. I am humbled for the opportunity.
“Tomorrow morning at 8:00 we will have the ribbon-cutting and then start the actual business of seeing patients, ready or not! At this point, I can only pray that God will bless this practice, as I use the gifts, talents and passion that He has given me to bless the people that walk through our door. Tomorrow starts the next chapter of my life!”
This excerpt is from my first blog entry. I wrote this the day before I prepared to open the doors and welcome patients into my brand new practice. I was feeling so many emotions! Excitement, stress, peace, fatigue, joy.
I took a big leap of faith, and looking back on the past year in private practice, I see God’s blessings in every area of my personal and professional life.
This month marks a huge milestone for me. I’ve successfully made it through one year in this new chapter of my life. It is important for me to stop and reflect on my influencers and supporters and share my thankfulness to so many people who have made this year possible:
I’ve built such a wonderful, thoughtful and knowledgeable team of women around me! They have supported me every step of the way and have truly caught the vision for what we are doing here. Patients truly see a difference when they come to the office. I get comments from patients almost daily that they have never been to such a great doctor’s office where everyone is helpful and cares about them. I’m so proud of each one of them.
MY REFERRING DOCTORS
I am so thankful every day for the valuable relationships I’ve fostered throughout the years with Houston-area doctors. These colleagues have supported my practice and believed in my team to provide quality urological care as they refer their own patients for us to take care of. We do not take it for granted and strive to provide great service at all times.
I have learned so much from other physicians who are further down the path than I am. They have been so generous to share their wisdom and insight. There are many pieces that have to fit together when you start a new practice, and my mentors have been great to help me put it all together.
I owe so much to my loyal patients. These women have trusted me and my team to provide solutions for their urological needs, and I am always blessed by their kind words, success stories and commitment to Houston Female Urology. You are the reason I am here, and I hope to continue to earn your trust and loyalty for many more years to come.
Most importantly, my family has stood beside me through thick and thin. They have shared in my successes and encouraged my spirit. None of this would be possible without my amazing husband and two children! They have been great cheerleaders while I have embarked on this endeavor.
This journey is only beginning…I have so much to look forward to throughout the coming years! I can’t wait to continue to develop and grow Houston Female Urology as we seek to provide expert medical advice, life-changing procedures and uncompromised personal care to every woman who walks through my door.
From the bottom of my heart – thank you.
It is 8/8/14. We opened our doors 7/7/14, so that means we have one month under our belt!! Woohoo! We did it/are doing it! Things are coming along very well. We have helped almost three hundred ladies with their urological issues so far and have registered almost 400 into our system for appointments. We’ve started doing surgery through the new practice: some bladder repairs and a few stones. And our pelvic floor program is in full swing. We have been busy!
I truly feel blessed. This is the realization of a dream that I have had for many years: to have a urology clinic for women and to have my own practice. It is so fulfilling. Everything is the way that I have envisioned it: a beautiful, calm, clean office where patients can feel assured that they will be treated gently and professionally. My staff is amazing. They have put their heart and soul into this start-up and they truly see this as a mission to help women and not just another job. I am so proud of them. And, we have a lot of fun together!
There are of course, moments of doubt. These are brief moments, but a frustration will occur and I will think, “what have I done?!?” Gulp. But in those times, I stop and think, “Christi, remember who is in ultimately in control here. Who has orchestrated everything to make this happen? Who has paved the way, given you the desire to be a doctor since you were three years old, opened up and closed the right doors along the way? God has got you, and He has your practice, too. The whole thing is squarely in His strong hands. Rest. Don’t worry. This is His practice.” He gives me a strong peace and courage to continue forward. It’s all going to be good.
So, I am incredibly blessed and thankful and peaceful about this adventure. Life is too short not to make big moves and walk by faith! If I weren’t a Christian, I would be a wreck, I think. But knowing that God has already paved the way and having His peace, I can relax. I can just lean on Him and go step by step. He has placed me here at this time, and my job is to trust Him and share the love of Christ through urology!
Well, we’ve almost completed our first week of the new practice! Oh, boy! I am pretty exhausted. And I feel like I have ADD. One minute I’m discussing surgery with a patient, the next fine-tuning the process of ordering tests, next hanging a scope sterilization caddy on the wall, next minute learning about Google Adwords.
It’s like when you are trying to clean your house and you move the blanket to your bedroom, only to see a cup that needs to go to the kitchen, and in the kitchen is your child’s backpack that needs to go to their room. Like that. But it’s every day, all day. 7a-7p. I am not really stopping for meals, just working and grazing.
It’s all-consuming. I can’t stop thinking about the new practice and trying to get every little thing just the way that I think it should be. I know that the day is coming when I will again mostly be spending my time practicing medicine, my first love, and spending less time on the business part, which I like, but it wears me out. It doesn’t feed my soul the same way.
I do love it, though. Building something. Creating a business and a place of healing. Helping people with their bladder problems. Yes, I’m a doctor who hasn’t lost the drive and satisfaction to help people. That is what keeps me from burn-out. Keeps me going no matter what frustration comes along. It is just the best feeling to have a patient smiling and hugging you, because she doesn’t need to wear pads anymore.
I love that I’m also able to employ some great women and (hopefully) help them realize the life that they dream of. And I couldn’t do any of this without their dedication. I truly get so much more from them than I give to them. We have a great team, and everyone has the vision to fulfill the mission of our practice. And we have a lot of silly fun as seen on the Facebook page.
Some of the challenges and frustrations that we’ve encountered: Well, day one, the Comcast internet wasn’t working. In fact it has gone down a couple more times since then. We have a new modem now, so hopefully that will help. And hey, Comcast sent me a $20 credit today! Internet is essential because our medical records are cloud-based. Thank goodness that Methodist has a free guest wifi. Otherwise, I’d have to pay for a backup internet service.
Challenge two: As much as we tried to learn the new Kareo electronic health records (EHR) ahead of time, there is just no way to know all the ins and outs until you go live. Day 4 now, it is getting much easier. We have figured out some good shortcuts.
Challenge three: Today we started using our Phreesia pads. I was hoping they would be ready Monday, but they weren’t. Another lesson in letting go of the desire for perfection! These are like ipads that patients use to check in and pay their co-pay. Very cool. At first, they didn’t work too well, but by the end of the day we were starting to see the light. Patients seem to like them. Decreasing paper waste!
We started out the week with one patient per hour so that we would have plenty of time to figure everything out and that was key. I’m still going to limit the number of patients for a while until we really start to feel like we are getting efficient. The patients have been so wonderful and patient with us. Sweet ladies.
I say we’re off to a good start! I think we are all tired and longing for the smooth-running machine that we all know we are capable of. It will take some time, but each day gets a little easier. It’s like the beginning of a run when you are sucking wind and just want to slow down or stop. BUT, if you can get past mile 3, the breathing gets easier, you reach your stride, and then you are cruising for the long run.