Sonam Bhandari 

HPPA 514 Reflection essay 

In this essay, I will identify reasons that led me to choose to become a PA, the aspects of clinical practice that would likely be most important to me and explain how my clinical practice would be guided by the principles of autonomy, beneficence, and confidentiality. 

My interest to become a PA stems from my desire to be a compassionate, capable, and knowledgeable provider to help bridge the communication gap between providers and patients in underserved communities. As an immigrant, I have noticed firsthand the inequitable medical care provided to members of my community meaning the Nepali community, mainly due to poor health literacy and lack of health care providers from my community – As a PA I would be able to add to the diversity of the profession and have the ability to impact the health of underserved communities by focusing on finding methods to increase health literacy (Bhandari, S., 2018). This profession allows me to impact the lives of many, by treating their illnesses, while also giving me the flexibility to switch between specialty and allow for a healthy work life balance which results in decreased burnout (Essary et al. 2018). 

As my decision to become a physician assistant stems from a desire to reduce health care disparity, I anticipate effective communication with patients and the medical team and being a competent provider to be most important to me. I have, as have other students in our class, experienced firsthand the disregard some providers have for patient’s emotional and sometimes physical concern leading to poor patient outcomes. I want to counter that by building relationships and trust with patients, while recognizing and respecting cultural differences, in order to decrease the reluctance of stigmatized groups to seek medical care to improve their health outcomes (Persaud, H., 2019). Being an effective communicator and a competent provider in a team-based practice brings about optimal patient outcomes by increasing health literacy and reducing preventable medical errors (Burgna, R. 2019). I hope to be able to communicate to the patient’s information pertinent to their health in a manner that is understood and that would help them make their own decisions while reducing any adverse events that may be caused by miscommunication. 

I would anticipate the ethical principles of autonomy, beneficence, and confidentiality to play the strongest role in my ethical decision-making in clinical practice. Autonomy states a person’s right to make their own decisions regarding their life and health (yeo et al, 2010). Beneficence means taking actions that provide benefit and reduce harm (yeo et al, 2010). Confidentiality is a practice that brings about trust and helps build relationship between patient and provider with the intent of preventing harm, respecting persons and optimizing outcomes (Kirk, T. 2015). 

            Effectively communicating with patients while utilizing cultural competency and using health literacy services such as an interpreter or using teach back methods would increase the benefits of having patients understand important information about their health while also improving health literacy (Persaud, H., 2019). It also reduces the likelihood of harm to the patient that may have been caused by not being able to effectively address patient’s concern or by the patient misunderstanding instructions for example, not taking the correct dosage of the medication. As PAs work in a medical team to provide care it is essential to have proper communication between members of the team and be competent to properly provide care for the patient. In our “teamwork training” lecture we learned of Sue Sheridan whose husband’s diagnosis of cancer was not communicated between the pathologist, the neurosurgeon or his primary doctor leading to his cancer being untreated and ultimately to his death. He only found out about his cancer when he went back to his pcp 6 months later, as his symptoms worsened. With proper communication between the providers caring for her husband, his prognosis could have been better. Being a competent provider – through continuing medical education has the benefit of ensuring that accurate diagnosis is made quicker and providing the patient with the options of all possible treatment options. Effective communication with patients and the medical team, and being a competent provider provides the benefit of increased favorable patient outcomes and reduces the likelihood of harm to patient caused by miscommunication and incompetency- consistent with the principles of beneficence. 

            In order to have patients practice with autonomy it is important to ensure that they are well informed about all the choices that they have. Since I plan to work towards reducing health disparity by improving health literacy in a community (south east Asian) where I could make the biggest impact, It would then be important to update my medical knowledge in order to educate the patient and be able answer any questions they may have regarding either treatment options (the risks, benefits and any adverse effects), their diagnosis or other health concerns. While having this knowledge is important it is even more important to be able to effectively communicate this information in a way that is understood by the patient and that it allows the patient to practice with autonomy. Using shared decision making to decide on a treatment plan with the patient requires effective communication and requires me to respect patient’s autonomy. 

Recognizing and respecting cultural differences while interacting with patients would allow for formation of relationships with patients who might otherwise be used to negative interactions with other providers. Cultural competency has been shown to improve individual health and build healthy communities and is required to effectively deliver quality care (Persaud, H., 2019). Different Cultures and religions have different stigmas associated with physical or mental health that need to be understood while providing medical care. For example, there is a big stigma against mental health in my community where they either attribute it to someone casting an evil eye and don’t believe in seeking help for it. Understanding this hesitancy to seek care and guiding a conversation in a sensitive way and provide them with information that may change or challenge their stigma,  while ensuring that confidentiality would be maintained may make them more open to treatment for their mental issues or physical ailments that they are ashamed to talk about, for e.g. Impotence. The understanding and respect leading to building of trust with patients can be made stronger with maintaining confidentiality, which in the long run optimizes outcomes by having the patients seek help/ get treated for illnesses that they would not have otherwise. Maintaining confidentiality then would require recognizing and respecting cultural differences by respecting person, optimizing outcomes and preventing harm that can be caused by the untreated illness (Kirk, T. 2015). However, when maintaining confidentiality does not support the principle of beneficence, I would consider disclosing the information. For example, in the case of suspected child abuse I would disclose the information after sensitively broaching the topic to the patient even if the patient requests nondisclosure. 

Here I have identified reasons that led me to choose to become a PA, the aspects of clinical practice that would likely be most important to me and demonstrated how my clinical practice would be guided by the ethical principles of autonomy, beneficence, and confidentiality. 

References: 

1. Bhandari, S. 2018. Personal Statement. 
2. Brugna, R. 2019 “Teamwork Training” ppt, lecture 
3. Essary, A. C., K. S. Bernard, B. Coplan, R. Dehn, J. G. Forister, N. E. Smith, and V. L. Valentin. 2018. Burnout and job and career satisfaction in the physician assis- tant profession. A review of the literature. NAM Perspec- tives. Discussion Paper. National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201812b. 
4. Kirk, Timothy W.  “Confidentiality.”  In Nathan Cherny, Marie Fallon, Stein Kaasa, Russell Portenoy, & David Currow, eds.  Oxford Textbook of Palliative Medicine. (5th ed.)  New York/London:  Oxford University Press, 2015, 279-284.
5. Persaud, H., 2019. “Cultural issues in health care” ppt, lecture 
6. Yeo, M et al. (2010). Autonomy  [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.
7. Yeo, Michael et al. (2010). Beneficence . In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.
8. “TeamSTEPPS: Sue Sheridan on Patient and Family Engagement”. 2015https://www.youtube.com/watch?v=Hgug-ShbqDs