{"id":9935,"date":"2016-12-13T09:25:06","date_gmt":"2016-12-13T17:25:06","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/medex\/?post_type=post&#038;p=9935"},"modified":"2022-04-04T19:58:47","modified_gmt":"2022-04-04T19:58:47","slug":"coming-out-the-other-end-surviving-and-thriving","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/medex\/magazine\/2016\/12\/13\/coming-out-the-other-end-surviving-and-thriving\/","title":{"rendered":"Coming Out The Other End, Surviving and Thriving"},"content":{"rendered":"<p><span class=\"dropcap\">A<\/span><strong><span style=\"font-size: 18pt\">t age 21, Frank Boyd was hospitalized<\/span><\/strong> with a pulmonary embolism, an event that was to change the direction of his life. For the two months of his hospitalization in 2001, he watched and listened as the nurses cared for him. \u201cI started asking them questions,\u201d he says. \u201cAfter that, I knew where my career was. It was in nursing.\u201d<\/p>\n<p>Given that Frank was employed in the constructions trades, the transition to a health profession was unexpected. \u201cIf you knew me before all of this you would never have predicted I\u2019d go into medicine, or to be a nurse in particular. I was not that person.\u201d<\/p>\n<p>But it was his firsthand experience of being a patient in the hospital that gave him empathy for others going through the medical care system. For nine years, Frank Boyd worked as a nurse in the Intensive Care Unit in the University of Kansas Medical Center.<\/p>\n<div><div id=\"amw_galleria_slideshow_1\" class=\"amw-galleria-slideshow\"><\/div>\n<script type=\"text\/javascript\">jQuery(document).ready(function(){ jQuery(\"#amw_galleria_slideshow_1\").galleria({\"dataSource\":[{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A1-Frank-Boyd-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A1-Frank-Boyd-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A1-Frank-Boyd-150x150.jpg\",\"title\":\"A1-Frank 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Boyd\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A10-Frank-Boyd-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A10-Frank-Boyd-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A10-Frank-Boyd-150x150.jpg\",\"title\":\"A10-Frank Boyd\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A4-Frank-Boyd-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A4-Frank-Boyd-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A4-Frank-Boyd-150x150.jpg\",\"title\":\"A4-Frank Boyd\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A3-Frank-Boyd-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A3-Frank-Boyd-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A3-Frank-Boyd-150x150.jpg\",\"title\":\"A3-Frank Boyd\",\"description\":\"\",\"altTag\":\"\"},{\"image\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A11-Frank-Boyd-1024x683.jpg\",\"big\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A11-Frank-Boyd-1024x683.jpg\",\"thumb\":\"https:\\\/\\\/familymedicine.uw.edu\\\/medex\\\/wp-content\\\/uploads\\\/sites\\\/3\\\/2016\\\/12\\\/A11-Frank-Boyd-150x150.jpg\",\"title\":\"A11-Frank Boyd\",\"description\":\"\",\"altTag\":\"\"}],\"width\":\"auto\",\"height\":0.76,\"autoplay\":false,\"transition\":\"slide\",\"initialTransition\":\"fade\",\"transitionSpeed\":0,\"_delayTime\":4000,\"_hideControls\":false,\"_thumbnailMode\":\"grid\",\"_captionMode\":\"on_expand\"}); });<\/script><\/div>\n<p>\u201cPatients are obviously scared,\u201d he says. \u201cThey&#8217;re in the ICU, so they&#8217;re close to death. In some sense, I know what that&#8217;s like. I know the fear of their family members, that they&#8217;re as scared if not more so than the patient. The patient is sick and might not really understand what&#8217;s going on. The entire time their loved ones are lying there in bed, you&#8217;re explaining things to the family members. There\u2019s a good chance of them dying, or not coming back the way they were.\u201d<\/p>\n<p>That was serious business, life or death.<\/p>\n<p>Right now, Frank is in his second year at MEDEX Northwest\u2014the clinical year\u2014studying to become a physician assistant. We caught up with him during a one-month surgical rotation at Group Health Central Hospital under preceptor Neil Weigand, PA-C, himself a graduate of MEDEX Seattle Class 39 in 2007.<\/p>\n<p>Frank, so accustomed to the adrenalin of urgent care, is adjusting to patients who come in for routine exams and procedures. \u201cA sick kid, I don\u2019t know much about,\u201d he says. \u201cAre they really sick, or is this just a cold? Whereas you can be an older adult that is bleeding out or really septic, and I know exactly what to do. It\u2019s an odd situation. I\u2019m less familiar with the less acute patients.\u201d<\/p>\n<p><span class=\"dropcap\">B<\/span><strong><span style=\"font-size: 18pt\">ut Frank is in learning mode,<\/span><\/strong> and he\u2019s a quick study. At Group Health, Neil Weigand along with other PAs and physicians have assumed a role in his education. \u201cThey\u2019re really great about helping me out, teaching me new things, grabbing me when there\u2019s something interesting going on. They\u2019re giving me a good, well-rounded experience of in-patient stays with surgical patients.\u201d<\/p>\n<p>As an ICU nurse, the in-patient and patient management aspects were completely routine to Frank, but the surgical portion is something entirely new. \u201cI\u2019d never been in the OR for more than an hour or two when I had to manage something about a patient as an ICU nurse,\u201d he says. At Group Health, he\u2019s worked as a surgical first assist, executing lots of surgical closures.<\/p>\n<p>We wonder how his skills with closure stitches have come along.<\/p>\n<p>\u201cOkay,\u201d he says. \u201cThe speed is not there yet, but they look nice.\u201d<\/p>\n<p>Frank views his years in nursing as something that informs his current direction. \u201cI enjoyed my experience as an ICU nurse,\u201d he says. \u201cI wouldn&#8217;t go back and become a PA at 21 years old. I sat with patients at their bedside, something most PAs don\u2019t experience, or even nurses outside of the ICU. I watched people go through these things and come out the other end, surviving and thriving.\u201d<\/p>\n<p>Now, with his sites set on the PA profession, Frank sees a different emphasis.<\/p>\n<p>\u201cI\u2019m looking to prevent people from being in the hospital in the first place,\u201d he says. \u201cI don\u2019t want to see these patients in the ICU anymore when we could prevent this.\u201d<\/p>\n<p><span class=\"dropcap\">F<\/span><strong><span style=\"font-size: 18pt\">rank is outspoken<\/span><\/strong> about what he sees as a healthcare system that is not geared towards prevention. \u201cMy frustration with our current system is that it&#8217;s built to fix broken people. We can prevent the brokenness in a lot of cases\u2014not all, but most cases.\u201d<\/p>\n<figure id=\"attachment_9957\" aria-describedby=\"caption-attachment-9957\" style=\"width: 400px\" class=\"wp-caption alignright\"><a href=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/Frank-Boyd-Vertical.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-9957\" src=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/12\/Frank-Boyd-Vertical.jpg\" alt=\"\" width=\"400\" height=\"600\" srcset=\"https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/12\/Frank-Boyd-Vertical.jpg 800w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/12\/Frank-Boyd-Vertical-200x300.jpg 200w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/12\/Frank-Boyd-Vertical-683x1024.jpg 683w, https:\/\/familymedicine.uw.edu\/medex\/wp-content\/uploads\/sites\/3\/2016\/12\/Frank-Boyd-Vertical-768x1152.jpg 768w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><\/a><figcaption id=\"caption-attachment-9957\" class=\"wp-caption-text\">Frank Boyd worked for nine years as an ICU nurse before entering MEDEX.<\/figcaption><\/figure>\n<p>What Frank is talking about is the fact that medical insurance does not allow providers to bill for patient education. This leaves huge holes in patient care. A provider can bill an open-heart surgery at thousands of dollars, but they must apply a dramatically lower billing code for an outpatient appointment to educate patients.<\/p>\n<p>\u201cIt takes more than 15 minutes to educate a patient,\u201d Frank says. He saw this every day in the ICU. \u201cPeople were told, \u2018Well, you\u2019re diabetic,\u2019 but not given instructions on what to do with nutrition, with their meds, nothing. We are not listening to our patients like we should in the first place. It\u2019s important that we\u2019re able to see where they&#8217;re at and then help as they need to be helped. We just give them orders and hope it works out, and when it doesn&#8217;t, we&#8217;re surprised. Well, we shouldn&#8217;t be. We\u2019ve failed them.\u201d<\/p>\n<p>Drawing upon his own experiences as a patient, Frank sees an advocacy role in his new career.<\/p>\n<p>\u201cAs a PA I hope to be empathetic as a way to get into patients\u2019 lives before they land in the ICU,\u201d he says. \u201cIn the ICU I\u2019m kind of powerless, except to try and do what\u2019s best for them in the moment. But it\u2019s too late in most cases.\u201d<\/p>\n<p>As a physician assistant Frank hopes to intervene with patients prior to their first admission. At the very least he\u2019d like to see medicine take a more active role in educating patients about making better choices as a way to prevent them from cycling in and out of hospitals. That said, he doesn\u2019t believe scaring patients has any effect. \u201cInstead, I like to emphasize the importance of what they can do for their own health, and get family members involved as well. That would save a lot of money, a lot of time, a lot of pain for them, and a lot of frustration for us as medical professionals.\u201d<\/p>\n<p>Frank continues. \u201cEither way you look at it\u2014whether you&#8217;re conservative, democrat\u2014it doesn&#8217;t really matter. The issue is that preventative care is dramatically cheaper. And it prevents people from having to go through heartache. The lifestyle improvements these people can have is dramatic. I don&#8217;t see why there would ever be an argument with this. One of the obstacles I see is our insurance billing system.\u201d<\/p>\n<p><span class=\"dropcap\">P<\/span><strong><span style=\"font-size: 18pt\">reventive care doesn\u2019t get headlines.<\/span><\/strong> \u201cMost other countries have figured this out, but it isn\u2019t sexy.\u201d \u201cPrimary care is looked down upon, which I don\u2019t understand. They have to be good at a little bit of everything. They have a broader knowledge than I would ever have as an ICU nurse. Primary care isn\u2019t seen as exciting, it\u2019s not billable; you can\u2019t make money. I can make 75 bucks for a patient visit, or I can be in ICU and make $250 for a visit for the same 30 minutes.\u201d<\/p>\n<p>Frank doesn\u2019t question medical students who graduate and plan to go into medical specialties. \u201cThey leave $300,000 in debt, and are offered $150,000 a year when they come out in their mid 30s. I don\u2019t blame them for going that route.\u201d<\/p>\n<p>Of course there are PAs who move into specialty medicine as well. \u201cEven those of us planning on specializing still feel that family medicine holds an important role in our system that cannot be forgotten. In the back of our minds we\u2019re thinking about nutrition, exercise, all of those preventive measures\u2014really basic and cheap solutions\u2014that can make huge lifestyle transitions for patients rather than another pill.\u201d<\/p>\n<p>\u201cBut if our system is built where I can bill for the pill, but I can&#8217;t bill for the education, that&#8217;s wrong. It doesn&#8217;t make sense.\u201d<\/p>\n<p>Frank believes that healthcare must improve its effectiveness with education and listening to patients. From there, systems can be built that are most effective at addressing patient needs. As things are today, neither patients nor medical providers are well served.<\/p>\n<p>\u201cWe\u2019re burning out our providers,\u201d says Frank. \u201cWe&#8217;re working harder, longer hours and getting worse outcomes. Even if we are making more money, in the end, for the majority of us, it&#8217;s still burning us out. I couldn&#8217;t see those poor outcomes over and over again when there&#8217;s a system out there that can be fixed.\u201d<\/p>\n<p>Franks sees the possibility of real change coming about through professional and political alliances.<\/p>\n<p>\u201cPhysician assistants don\u2019t have much clout because there just aren\u2019t that many of us compared to nurse practitioners and medical boards. We\u2019re smaller by a wide margin. But I think PAs can partner with groups like the American Medical Association, the Washington State Medical Association and the nursing board here in Washington. We\u2019re all aiming for the same things: improved healthcare and lifestyles for healthcare providers that the current system is not allowing.\u201d<\/p>\n<p>Frank believes the current healthcare system can be changed through combined lobbying efforts to allow for billing of patient education. \u201cInstead of being told we\u2019re doing a poor job, we could be effective at what we started this job to do. 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});<\/script><\/div>\n<p><span class=\"dropcap\">I<\/span><strong><span style=\"font-size: 18pt\">t\u2019s clear that Frank Boyd isn\u2019t shy<\/span><\/strong> about speaking his mind. We wonder how he developed such candor.<\/p>\n<p>\u201cIt might be a little bit of a Mid-Western thing\u201d, he replies. \u201cI\u2019m from Kansas, and we&#8217;re pretty straightforward. We don&#8217;t hide much. We&#8217;re nice, but if there&#8217;s something wrong, we&#8217;re going to address it, and sometimes we may irritate people by doing that. I worked with four nurses from Kansas at my last job. And we were known as \u2018The Feisty Kansans\u2019. If we saw something wrong with patient care, with staffing or something, and we would fix it. We wouldn&#8217;t just complain about it. This wasn&#8217;t to hurt people&#8217;s feelings. It was because there was a problem that needed to be solved, and we had the power to do it.\u201d<\/p>\n<p>Group Health Central under Neil Weigand is Frank\u2019s third clinical rotation and fulfills his surgical requirement. Next he will be at Bellevue Group Health in Urgent Care, an area more familiar to Frank after his nine years as an ICU nurse. His clinical year concludes with a 4-month family medicine preceptorship in Port Townsend, WA that starts in April of 2017. Graduation follows at the end of August.<\/p>\n<p>We ask Frank where he sees himself after leaving MEDEX Northwest.<\/p>\n<p>\u201cI&#8217;m trying to allow these rotations to kind of shape where I&#8217;m supposed to belong in medicine,\u201d he says. \u201cI&#8217;ve had a past in ICU, and I see those skills that I&#8217;ve utilized in this rotation even now. I don&#8217;t want to throw away those experiences and that knowledge that I have for in-patient medicine.\u201d<\/p>\n<p>\u201cWhat I hope to gain as a PA is the medical knowledge and the credibility to be able to work in people&#8217;s lives outside of a hospital, to be in primary care. Even to become a hospitalist if I choose, or perform surgery for minor procedures\u2014anything I can do to help prevent these huge catastrophic events.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Eleven years as an ICU nurse have made Frank Boyd highly aware of the shortcomings of US healthcare systems. He\u2019s an advocate for patient education as a means to interrupt the cycle of patient readmissions. Now in his clinical year as student in the MEDEX Northwest physician assistant training program, Frank is hopeful of applying empathy and active listening to achieve positive patient outcomes. <\/p>\n","protected":false},"author":1,"featured_media":9937,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[21],"tags":[],"class_list":["post-9935","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-experience"],"cp_meta_data":{"_edit_last":["1"],"student_name":["Frank Boyd"],"_webdados_fb_open_graph_specific_image":[""],"_thumbnail_id":["9937"]},"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/9935","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/comments?post=9935"}],"version-history":[{"count":1,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/9935\/revisions"}],"predecessor-version":[{"id":17220,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/9935\/revisions\/17220"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media\/9937"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media?parent=9935"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/categories?post=9935"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/tags?post=9935"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}