Apocalypse! Crisis! Disaster!
by Steven D. Johnson, PA-C| Geriatric Times |  |
January/February 2001 | |
Vol. II | |
Issue 1 |
We live in an age of excess information and media exaggeration. We live in an age of hyperbole. Stories of crises dominate the press, with each medium looking for a different angle to better sell that story for that day.
The coming "geriatric crisis" is certainly a story we have all heard. What is reasonable to expect is an increase of older Americans. This increase will challenge our already taxed health care system. It will cost money to address. Primarily, it will require cooperation between the health care professions.
There are serious challenges facing our existing health care system in meeting the current demands for health care-let alone those of a burgeoning elder population. Certainly one of the most critical challenges is ensuring that we have sufficient health care providers. A workable model to meet the need is the physician and physician assistant (M.D./PA) team.
I am a PA working at the Palo Alto Medical Foundation, a multispecialty clinic of 20+ physicians. During the first 13 years of my career with the foundation, my primary role was to support a geriatric physician with skilled-nursing facility visits, home visits, evaluations and follow-up care for older adults. The job was clinically challenging and emotionally and spiritually satisfying. I represented my supervising physician and our organization as we cared for the most frail older adults either living on a functionally tenuous margin at home, dying at home or surviving in the nursing facility.
The physician and physician assistant model works to extend the physician's expertise in diagnosis and treatment and to increase the availability for on-site management and communication for complex geriatric syndromes (e.g., falling, incontinence, fatigue, instability, depression, dependence, functional decrement and acute illness). Financially, PAs are more cost-effective than their M.D. colleagues; and, by supporting the physician/patient relationship, the PA is identified as the physician's representative.
Exceptional care for the elderly is team-driven. The physician's role is to diagnose and treat illness. Often the care is given by the other members of the team who support the family. Good care is a concert of communication, effort and professional responsibility by the primary care physician, nurse, physician assistant, physical therapist, occupational therapist, specialist physician, hospice, community resource outreach, nursing assistant, administrator and others.
We may not be facing a crisis or disaster. We are certainly facing a considerable challenge in meeting the needs of our aging, multicultural American society. If we work together to address these challenges, we will be able to truly offer our best. Otherwise, only our patients will suffer.
Mr. Johnson is coordinator for non-physician providers at the Palo Alto Medical Foundation and a member of Geriatric Times' editorial advisory board.