The Keystone of PA Training and Patient Care is Perception and Positive Thinking

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Physician assistants (PAs) are licensed medical professionals trained under the same medical model as physicians, though their education incorporates some key distinctions within the medical community. For almost 60 years, PAs have been integral members of the healthcare team. The Bureau of Labor Statistics is projecting a nearly 28% increase in employment over the next 10 years—one of the fastest-growing professions in the US.¹

What's behind their massive growth? PAs are not only highly trained in the medical sciences, but also in the art of patient communication and the psychology of healing. They are trained to integrate the power of perception and positive thinking into patient care, embodying a holistic approach that considers the emotional and psychological needs of patients as well as their physical health. This dual focus on clinical excellence and empathetic patient engagement is what makes PAs uniquely stand out in their approach to care. Much like the principles outlined in the narrative of Eliza Doolittle from “My Fair Lady,” where treatment by others significantly defines one’s self-identity and capabilities.²

The PA curriculum emphasizes the importance of positive thinking and the Pygmalion effect in clinical settings. PAs are taught to maintain high expectations for their patients’ outcomes, understanding that their beliefs can subconsciously influence how patients perceive their own potential for recovery. This training is grounded in evidence suggesting that a patient’s perception of their provider’s confidence in them can directly affect their health outcomes.³

For example, PAs are trained to practice reflective listening or mirroring, a technique that ensures patients feel understood and valued. When a patient expresses concerns about their treatment, a PA might respond with, "It sounds like you're worried about how the medication will affect your daily routine. Let’s explore how we can address this concern together." This kind of response not only acknowledges the patient's feelings but also conveys the PA's belief in the patient's ability to manage their treatment, reinforcing the patient's confidence.

PAs also employ motivational interviewing, a method that involves asking open-ended, calibrated questions and encouraging patients to verbalize their motivation for change. When a patient is hesitant to adopt a healthier lifestyle, a PA might say, "What benefits do you think you might experience if you started these healthier eating habits?" This question prompts the patient to envision a positive outcome, which can be more motivating than simply receiving advice.

In practice, PAs apply this knowledge by creating a therapeutic alliance with patients, fostering an environment where positive expectations are the norm. They are trained to avoid negative labeling and to use language that empowers patients. For instance, a PA will focus on the positive aspects of a patient’s progress, no matter how small, to build momentum towards greater health goals. Instead of simply instructing a patient to monitor their blood pressure, a PA might say, "I believe you can take an active role in managing your blood pressure. Let's work on a plan that you feel confident about." This approach fosters a partnership between the PA and the patient and builds the patient's self-efficacy.

These skills are desperately needed in today’s healthcare industry. Despite the US shelling out more cash on healthcare than many other established, wealthy countries, our health stats don't really stack up. Things like low life expectancy and high chronic disease burden. Worse are avoidable mortality and infant mortality, both areas where the US has the highest. Despite all that spending, our healthcare system isn't hitting the mark on some pretty key areas, including how long people live, the quality of care, and even how patients feel about their treatment.⁴

When you line up the US against other wealthy nations based on healthcare system performance, we're actually at the back of the pack. Not what you would expect from the world’s powerhouse. Especially when you consider how much of the country's budget goes into healthcare. This whole comparison really shines a light on the gaps—things like getting to see a doctor when you need one, how smoothly the system runs, making sure everyone gets a fair shot at quality care, and, ultimately, how healthy people are.5 

PAs are adept at individualizing patient interactions. They are skilled in interpreting not just medical data, but also the subtle cues that indicate a patient’s emotional and psychological state. This allows them to tailor their communication in a way that reinforces the patient’s self-efficacy and adherence to treatment plans. Celebrating small victories with their patients, PAs training can have a cumulative effect on the patient's outlook and recovery. A patient who has successfully managed their blood sugar levels for a week might hear a PA say, "Your dedication to tracking your blood sugar has really paid off. Let’s build on this success together." This positive reinforcement encourages continued progress.

The role of PAs in the healthcare system is vital, not just for their medical expertise, but for their dedication to maintaining a healing environment through the power of positive perception. They are the embodiment of the belief that the attitude of the healthcare provider, as an authority figure, can be as healing as the medicines prescribed. By expecting and encouraging the best from their patients, PAs play a crucial role in not just treating illness, but in nurturing wellness for us all.

By the growing trust in the profession, PAs cultivate a healing environment where patients are more than their symptoms—they are individuals with the capacity for resilience and recovery. It’s this blend of medical expertise and the nurturing of positive patient perceptions that underscores the value PAs bring to the healthcare team.

Michael Rubio, PA-C, is a physician assistant based in Brooklyn, New York, who is dedicated to addressing the primary care crisis by enhancing access to care in New York. He is a seasoned PA-C and the Co-founder of Well Revolution (www.wellrevolution.com), a secure platform designed to connect patients with their licensed primary care providers and pharmacies. This service enables same-day advice, diagnosis, and prescriptions, facilitating more efficient health care delivery.

References 

1. How does the U.S. healthcare system compare to other countries? Peter G. Peterson Foundation. July 12, 2023. Accessed February 27, 2024. https://www.pgpf.org/blog/2023/07/how-does-the-us-healthcare-system-compare-to-other-countries.
2. U.S. health care from a global perspective, 2019: Higher spending, worse outcomes? U.S. Health Care from a Global Perspective, 2019 | Commonwealth Fund. January 30, 2020. Accessed February 27, 2024. https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019.
3. The Pygmalion effect. The Decision Lab. Accessed February 27, 2024. https://thedecisionlab.com/biases/the-pygmalion-effect.
4. Alter C. My fair lady movie 1964: Why it’s much less sexist than you think. Time. October 21, 2014. Accessed February 27, 2024. https://time.com/3525216/my-fair-lady-1964/.
5. Brierly A. PA ranks as #2 best healthcare job by U.S. News & World Report. AAPA. January 10, 2023. Accessed February 27, 2024. https://www.aapa.org/news-central/2023/01/pa-ranks-as-2-best-health-care-job-by-u-s-news-world-report/.