|NEWSRoom | Source: Daniel Sean Kaye|
Presenting Explanations and Options with Compassion
For many of us, early experiences shape the future. In the case of Carl Diaz-Parker, RPA-C, AS, BA, a physician assistant and instructor in urology at the Urological Institute of North Eastern New York (NENY) in Albany, his parents modeled a life spent caring for others.
When he was a child, Diaz-Parker and his family lived on the grounds of Craig Developmental Center/State of New York Epileptic Asylum (SONYEA), a state-run facility for persons with mental retardation, located in the Genesee Valley region. His mother was a nurse there; his father was superintendent of the physical plant. His mother's devotion to her patients affected Diaz-Parker deeply; his father's avocation of hunting gave him an opportunity to learn basic anatomy.
Two childhood experiences in particular instilled in Diaz-Parker the profound desire to pursue a career in healthcare. In 1951, his parents' first child died at the age of two from an anaphylactic reaction to penicillin. "This was never talked about much in our home, which bothered me, but which I can certainly understand," he says. Then, when he was in third grade, his best friend suffered an adverse reaction to aspirin he was given to relieve flu symptoms. "He suddenly was hospitalized, and I was told he would not survive, since he had Reye's syndrome," Diaz-Parker recalls. "He did survive, but was [left] profoundly mentally retarded. I wanted to 'fix' Roger, but could not: I decided that I would try to help those I could."
His first exposure to a physician assistant came at age 16, when his mother took him to a PA with whom she worked for treatment of an arm injury. "I told him my symptoms and he started checking my shoulder, and I remember thinking, 'This guy does not even know my elbow from my shoulder.' Then he pushed on one spot, and the pain shot down to my elbow. He explained that I had tendinitis, and the anatomy behind the cause and how to treat it. I was amazed," he says.
Later, Diaz-Parker and his wife completed PA school at AMC/HVCC (Albany Medical Center/ Hudson Valley Community College) together. When they graduated, the couple was expecting a daughter. They took the NCCPA and surgery exams, and after receiving their results, Diaz-Parker immediately began applying for positions. Just three weeks later, he accepted an offer to work in urology at NENY. "I tease that I am the chief physician assistant -- but that is only because I am the only PA," he says.
Today, Diaz-Parker works for a group of five urologists, including one who specializes in pediatric urology. Originally a division of the department of surgery at Albany Medical Center, the group split off to join more than 100 local primary-care doctors and radiologists, forming a new entity, Community Care. "The hospital had been requesting some groups to privatize in the past few years, and our group thought it better to do this on our own schedule, instead of waiting for the hospital to choose the time. I was leery ahead of time, but so far it has worked to my benefit," he says. "The group has very good management personnel and when they make a decision it is logical, well researched and timely."
The group's three major areas of focus are: surgical and office-based urological care; the education of urology residents, medical and physician assistant students; and research. "We have the only regional pediatric urologist," explains Diaz-Parker. "We are one of the few regional centers to perform radical cystoprostatectomies with continent urinary diversions."
Among Diaz-Parker's responsibilities is seeing new, follow-up and postoperative clinical patients. He treats about 20 to 25 people per day (reviewing results, interviewing patients, performing physical exams, discussing diagnoses and treatments with patients and ordering appropriate testing), and also monitors voice-mail messages for the nurses. Diaz-Parker performs post-void bladder ultrasounds, gives intramuscular and subcutaneous injections, starts IVs, places or changes Foley or suprapubic catheters and implants subcutaneous medication pumps. He oversees intracavernosal injections for patients with severe impotence and weekly verapamil and marcaine penile injections for Peyronie's disease. In addition he serves as an instructor of surgery at the Albany Medical College, lecturing mainly to PA students.
"I am enthusiastic about what I do, and the doctors and patients see this," says Diaz-Parker. "I thoroughly explain the choices, whether for treating prostate cancer or for treating erectile dysfunction, and then clarify for patients why my suggestion is best suited for them. As explanations take time, many of these [duties] have been relegated to me. I explain complex things in an understandable way." He also says he helps to free up the physicians he works with for patient consultations by taking over some of the time-consuming procedures he is qualified to perform.
"I work 8:00-5:30, Monday to Friday, on average, with a rare lunch break. Most days I am happy if I get to use the bathroom," he says. "I am a sub-investigator on all of our current research projects, many of which are through pharmaceutical companies, so in addition to seeing my or the doctor's scheduled patients, I also do research physicals."
In fact, Diaz-Parker thinks that the primary challenge he faces day to day is time management. "I try to take the time to make certain that each person knows what they have, why we are suggesting any treatments, how that treatment works and the risks and benefits. My schedule does not slow to accommodate this, and so I often have many charts left over to dictate," he says. "What I like is helping the patients through their problems and seeing them back -- hopefully, but unfortunately, not always -- improved. There are some sad outcomes with younger people with significant cancer, but many more success stories to keep my morale up."
Maintaining high morale means a lot to Diaz-Parker. "I enjoy when the patients notice that I have a good attitude and really explain things well. Most people want information about the disease or problem, why it happens and what can be done. They want someone to listen to them and answer their questions. They want to be involved in the decision-making process, even if the decision is clear cut. If I [went to] a provider and they showed no concern, emotion or interest, I would not want to see them anymore. So, I treat people the way they want to be treated," he says.
This kind of sensitivity is especially important, given the delicate nature of the topics he discusses with patients. "I have to discuss very sensitive things like cancer, genitals, sex, orgasms, sexual practices and masturbation, which is tough to do with strangers," he observes.
Fortunately, Diaz-Parker is an accomplished speaker, having presented on these topics to a variety of audiences. He lectures for his local PA program, and has spoken at the National American Academy of Physician Assistants continuing medical education conference; at the New York State Society of Physician Assistants CME conferences; and at the local Capital Area Physician Assistant Society CME dinners. His topics have included erectile dysfunction, benign prostatic hyperplasia, prostate cancer, prostatitis, urethritis and epididymitis. "I look forward to speaking again on ED to providers or to the public," he says. "This lecture usually gets good laughs."
As someone who is active in state and national professional organizations, Diaz-Parker encourages fellow PAs to nurture their growing political clout. He believes this can best be accomplished by "using our relationship with medical organizations, as the NPs do with nursing unions, to maintain and improve our position. I think more PAs need to be involved in state and national organizations and to contribute money, so that lobbying can take place on our behalf. I think that we need to further the awareness of our profession, and I am working on this on a regional and national way."
Regarding emerging issues that are of concern to him, Diaz-Parker pulls no punches. "The biggest concern to everyone in medicine, I feel, would be the eventual nationalizing of healthcare," he says. "There is a better way -- and a worse way -- to do everything, as opposed to a right way and a wrong way. National healthcare could be a great thing for our country; but if done wrong, it could just as easily be a disaster. The government is not always known for being organized and efficient, so I worry about how the system would work and be organized." He points to the new Medicare patients' drug card, a development he characterizes as "a disorganized hodgepodge, which is not understood by anyone."
Despite his concerns, Diaz-Parker maintains a great faith in his profession and its ability to grow dramatically in the years to come. The key to continued growth, he suggests, lies in PAs embracing new challenges. "I see that PAs are expanding beyond primary care and surgery. We are now in all specialties, to the benefit of patients. I feel that I am an integral part to our practice." He is an important intermediary between patient and physician, providing patient education in a thorough, easy-to-understand manner.
To keep the PA field strong as its scope of practice expands, Diaz-Parker emphasizes that "strict standards need to be maintained for PA school candidates, PA schools, credentialing and postgraduate education." He adds that re-taking the credentialing exam every six years is crucial to maintaining high professional standards. He believes that taking a certification exam to compare one's knowledge to that of other PA graduates around the country is another important measure in the effort to make sure that he best and the brightest PAs will one day guide the field's development.
Carl Diaz-Parker, RPA-C, AS, BA, is a registered physician assistant with an associate's degree in science and a bachelor's of arts degree in Biology/Psychology, both from from SUNY Albany. He graduated from the AMC/HVCC (Albany Medical Center/ Hudson Valley Community College) physician assistant program in 1999, the same year in which he became certified as a PA by the NCCPA (National Commission on Certification of Physician Assistants). He also looks forward to earning a master's degree through Albany Medical Center's physician assistant program.
Daniel Sean Kaye is freelance writer based in the Philadelphia, PA, area. He is on the editorial staff of NEWS-Line for Physician Assistants.
Alan Kerr, PA, PhD, a friend and classmate of Diaz-Parker's, and a fellow PA, is currently on a medical mission to the Dominican Republic, where he is providing healthcare to Haitian migrant workers in the "baties" (sugar cane region), as well as providing medical care to the residents of an orphanage. If anyone is interested in making a donation to support his humanitarian efforts, Kerr's coordinator in the U.S. will gratefully accept checks sent to the following address:
Becky Mincey, 600 Market Street, Apt. 2, Spencer, WV 25276
phone: (304) 927-1865
Ms. Mincey will transfer the funds to Kerr via Western Union. If any colleagues would like to volunteer in the Dominican Republic, they may contact Alan Kerr directly by e-mail at [email protected], or by cell phone at 1-809-885-3916.
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