No red shirts in family medicine – Scott Naherniak and Dr. Permack

Dr-permack-and-Scott_Aug_2014In the TV series Star Trek the bridge is run by many different people, all with specific jobs that they are experts at, with the captain guiding and overseeing it all but trusting in their judgement and skills. In many episodes red-shirt security officers and engineers who accompany the main characters on landing parties often suffer quick demise. Thankfully, in family medicine we do not sacrifice our team.

My supervising physician is Dr. Permack, Manitoba Family Physician of the year 2014. There are no red shirts in his family practice crew. In the clinic where we provide care there is a lab, a counselor, a psychiatrist, and an office manager/patient navigator. We are successful because we operate as a team.

Dr. Permack has been in practice in south Winnipeg for 32 years. He practices across the spectrum of family medicine, acute care, long-term care, teaching, primary care and leadership. The practice was one of the first in Manitoba to adopt the provincially accepted electronic medical records. Dr. Permack is a graduate of the University of Manitoba and serves as the Medical Director of the Family Medicine Primary Care Program and Home Care Program for the Winnipeg Regional Health Authority.

The doctor and I share a panel of patients in our medical home that range in age from prenatal to palliative end of life care. We manage a floor in a personal care home, round on patients in the hospital, work in the primary care clinic and perform home visits on the vulnerable housebound. As a PA, I manage chronic disease; perform minor procedures, EKG, PFT, and ambulatory blood pressure monitors.

Dr. Permack has been very satisfied with the addition of a PA to his team and describes the relationship as follows: “I could not imagine the ways and extent that a Physician Assistant could help me in my Family Medicine career. The partnership with the PA affords me opportunities for personal development, to support innovation and to develop relationships with patients and other care team members while making such an impact on the lives of individual citizens and our community.”

Working in partnership, Dr. Permack and I follow the principles of Family Medicine, valuing continuity of care. We support therapeutic relationships that can be as long as thirty years in duration and even servicing as many as five generations of one family. We are community-based providers working with pharmacy, public health, home care, geriatric support services and mental health to keep our patients out of emergency rooms and support them and their families in their homes. By spending time as a team collaborating and co-locating, we learn and practice to be excellent clinicians as demanded by the College of Family Physicians.

The learning curve has been steep after graduating. This included a new skill set of quality improvement using EMR tools to improve care of patients on amiodarone, suffering from breast cancer and osteoporosis. Sharing tasks through EMR allows me to be a collaborator and communicator following-up with our patients regarding lab results and control of their chronic disease.

The obstacles we have encountered mostly relate to rules that have not adapted to the new interprofessional environment and professionals needing to be educated about the value of PAs across the spectrum of Family Medicine. I am a physician assistant, part of the family medicine crew, and I love what I do.