Typical days in PA and MN

What is the average morning of a patient advocate? Well, the PA will get up and start his day like everyone else. He will have his coffee. Rather than start on his regular day, his old life’s concerns, he will launch into the newer aspect of his personality- the Patient Advocate identity. Most likely, early in the morning he will get on the internet and noodle around for a few hours. This involves reading various sites and following up on various items, almost at random. It is not possible to miss a day of doing this. Much of the important information is accumulated over time, and the ability to realize any meaning does not necessarily come from the particulars - but from the particulars as they accumulate over time and as they build. The PA might pick up an item about garlic as a killer of pathogens one morning and following this thread out into the large field of the internet might or might not reinforce or yield some information that can be registered and recorded. Often the patient advocate will spend time writing notes or writing instructions to the patient. The PA might check his list of items and seek out appointments with doctors or copy and organize test records. Or the PA might make plans for future tests or read about the tests themselves and what benefit they might or might not bring. This kind of activity will go on for several hours in the morning and come to an end half way through the PA’s day. There is no school to which you can go to learn to be a PA. There is no test to take to determine if you have the requisite qualities to be a PA. No license, state or federal, is necessary to pursue the career as a PA. Who assesses the job efficiency of a PA? Perhaps there is a state agency that overseas the work of a PA, makes sure the proper forms are filled out, the taxes are paid?. Perhaps this same agency assesses fines in the case of a PA overstepping the proscribed limits of behavior? No, no such thing exists. You might still want to know how the job of a PA is assessed. Surely there must be someone who can judge the quality of this job – surely some committee can be formed and at least a self-assessment test filled out by the PA. No, this does not happen - but you still might here a PA in a café saying, “I feel good about myself and I think that I do a good job” But is that sufficient? You decide.

And notes of one day, among many, from Minneapolis:

A day, or part of a day
For instance yesterday I got up and went to coffee and read the paper for a few minutes. I had scheduled the phlebotomist to come slightly after 2. I had to confirm with this gal that she was coming. I had to wait to do this to make sure I didn't get a call from my daughter indicating that she herself was going to cancel. When the later morning arrived I got the drift that my daughter was going to be able to do this, as she had not called me. On the phone with the phlebotomist I had to go over the test that were on the requisition sheet. There were various questions as to which blood vials to use. Some tests, like the G6PD assay need to have a lavender top, also known as a purple top, with EDTA in it, a kind of preservative. Each test takes a different kind of vial and a different amount, say 3ml or 5ml. Earlier in the day I had gone over this on the internet, looking up the various configurations so that I got them right and so the phlebotomist got them right. About this time my phone was running out of batteries as it is near broken, so I had to head for a coffee shop so I could plug in my phone and make sure I can make and receive calls. After getting things straight with the phlebotomist I drove over to Clinic 1c at F. Hospital about ten minutes away and picked up the signed requisition from Dr. T's nurse. I had written her an email last week and they said they had it at the front desk of 1C. When I got there they had trouble finding it, but, as it was so important, I was persistent and they got ahold of it and off I went. So now I had the necessary requisition in my hand, which I was too late arriving in MN on Friday to pick up and now I had things straight with the phlebotomist and it looked as if the patient was going to be able to do this blood draw. I was scheduled to meet the phlebotomist outside of my daughter's house at shortly after two, as it is important that we not schedule these blood draws to interfere with her boyfriend's naps that take place between 12:30-2. We had a number of other tests to do at the same time and these each involve reading direction, arranging again for the correct vials - some need to be partially refrigerated and others need to be spun - like that. The forms all needs to be filled out and the billing arranged correctly and the doctor’s signatures gathered, all of which or most of which I did before. This time one test kit went to NJ and I had to call the lab to make sure about details of the requisition and the mailing and the payment. This particular test is fedexed overnight so I went down to find the FedEx central shipment place in South St Paul. I was really going there to check on another shipment to UK, which is more fractious. I previously had ordered these insulated boxes, as the sample need to go at ambient temperature and can't be frozen or heated up too much. FedEx has all sorts of rules about shipments, especially overseas with medical products and you need a triple form commercial invoice as well as the regular international waybill filled out. So I wanted to go to the source and make sure that this was going to be right, since I had gone to two other FedEx stores and gotten different stories in each one, including that they could not do these shipments at all. All this was at the end of a few months emailing and work to get this particular test done in UK and as I read my email yesterday morning early I found that the nice fellow at Biolab UK had written finally that the particular test that I wanted could not be shipped to Biolab any more but had to be shipped to Acumen. So I had to go back and change my entire invoice and run back to FedEx to make copies again and since my cell phone either was out of batteries or I was unfamiliar with the overseas calling, particularly the expense, I drove in hurry back to a friend's to make a few calls to UK. I went into her place and her dog, which had eaten a whole bunch of lamb bones two days earlier had thrown up all over the place. So I was cleaning this up as I was making several fruitless calls to UK, but finally got through to someone who told me what to do, or at least I think what to do. About this time I was gaining confidence after losing confidence and things seemed to be coming together although I did notice that the Acumen lab in Devon UK does have a P.O. box number, and I knew that FedEx does not deliver to P.O. boxes. So it was back to my daughter's house where I waited outside for the phlebotomist and she arrived right on time. This phlebotomist is a really good and helpful Christian soul. I had to go over with her again about a bunch of details as one of these tests has a special UK vial that needs to be filled and other details that I needed to get her. The blood draw was done successfully and I got my particular vials and my particular boxes and forms and I was off to FedEx. The patient sent out the other test kit supposedly and the phlebotomist took her stuff to M. Hospital lab, which usually is routine. I of course had a terrific struggle back at the central FedEx place in spite of having been there earlier in the day. This time is was a different and unhelpful woman, but I finally got the forms and vials and packing and plastic bag and instruction letter and requisition form together and packed correctly and off it went. I now know this particular routine- and I have no idea if it will really get to the lab it is heading for. At this point it was 3 and I am sorry but I have leave now. Sorry. Incidentally do not take the end of this writing episode to indicate that my day as a PA was over. It continued on, that day and the following days in MN and then back in Philly and NY.

Much of the time of the PA will be taken up with routine tasks. For instance just now the PA went to a college bookstore and purchased a binder and dividers for the test results that will be sent to Dr. de Meirleir. The PA will craft a letter, long enough to get across the essentials, short enough to be readable by de Meirleir, should he chose to read it. This is not the first time that the PA has crafted such a letter. He has done it on numerous occasions. The PA is never convinced that the doctor ever looked at the introductory letter or any of the tests. However the PA is not convinced that this is a necessary part of the equation. So the PA buys the proper folder and goes on to the office to use the college Xerox machine to copy the tests that he has chosen to send on. Fortunately for the PA he has a copier which he can use free of charge. He also has a fax machine that also is free for his use. Many faxes of tests results over many years time have come through this machine. After copying the tests, the PA continues on his bike and organizes the folder, and then the PA records his views and activities on this journal. During this entire time the PA gets the sense of having done a task and having done a task pretty well. The PA has the routine down and all that it takes to implement the routine is a little time and money. This goes on every day. The PA has his tasks every day, and the list of things to do stretches out into the future.