Having emigrated from India in 2003, I have always been interested in the healthcare of women in rural areas. Today, I am fortunate to work as a certified PA in a family medicine practice, which provides care to many women in the San Joaquin Valley of California.
Women PAs can help to meet the needs of women in rural areas by providing access to needed health programs and services, and offering the opportunity to be seen by a female provider. I think this also increases patient satisfaction as women may be more candid with another woman.
Many of my patients are undocumented farmworkers, who are dealing with language and cultural barriers as well as raising their children and trying to keep them in school.
While the demographic base of my practice may be different than yours, by and large women's health needs are universal. It is important to treat the whole woman, not just today's problem. This includes not only preventative physical exams, but also screening for mental health.
Most of my patients come to me through word-of-mouth referrals and I usually see 20 patients a day. Typically a woman will come in because of symptoms, like a cough or cold. While I handle the acute problem, I also use the opportunity to ask if they have had a Pap smear or a mammogram and try to schedule a physical. I want to have more time to do a total assessment: check for cholesterol, diabetes, hypertension, and more. Many of my patients put their families first and have neglected their own health for years. Of the 45 minutes I schedule for an exam, I spend at least 20 of those minutes on preventative education.
However, my goal isn't to just to provide acute care, I want to build relationships so these women will continue to come back for preventative and wellness services. I've found there are four primary reasons patients will schedule follow-up visits:
1. Family planning. Family planning is a big part of my practice. Teenagers and young women tend to be timid, and my priority is to be sensitive and find a personal connection. I smile, make eye contact, and sometimes hold their hand when I speak to them, so that I can gain their confidence. I explain birth control options and discuss STD prevention.
2. Depression and/or anxiety. During routine physicals, I frequently uncover symptoms of depression and anxiety. If patients are mildly depressed, I explain meditation techniques and may prescribe antidepressants and therapy. I have found that, often, even a short course of treatment can bring them back to feeling normal. For more serious issues, I refer to a psychiatrist or a psychologist. I also check to see if they may be in an abusive relationship, and if so, we look for community resources that can assist.
3. Weight loss. Female patients often ask about weight loss. The diet in this rural area seems to be high in fat and carbs. I provide basic nutrition counseling and explain carb and calorie counting. I also prescribe medication in the case of morbid obesity, but then I also refer to a nutritional or diabetes educator. Again, I stress prevention and educate patients about how they can take control of their weight and their health.
4. Menopause. For middle age and older women, I perform breast examinations and Pap smears and order mammograms. I ask about menopausal symptoms such as hot flashes and mood changes. I also educate them about natural alternatives to hormones, which have fewer or no side effects. At this point in their lives, they may have comorbidities that contribute to their symptoms. I help them understand menopause changes and manage any medications they are taking.
My goal is to treat patients the way I want to be treated — as if they were a family member. I'm fortunate to love what I do, and every day I thank my patients for the privilege of providing their care.
Hema Majeno, PA-C, emigrated to the U.S. from India with a background in radiologic technology. She worked as an X-ray technician before graduating from an accredited PA program and passing a rigorous, national certification exam. She is certified by the National Commission on Certification of Physician Assistants (NCCPA) and works for a community clinic in Parlier, Calif.
This blog was provided in partnership with the NCCPA.