Working as an Infectious Disease PA

Anne: I was ecstatic when Maureen agreed to come in for an interview! Maureen is a former CBC journalist turned Physician Assistant. She is a McMaster PA Graduate and currently works as a PA in Infectious Disease, and formerly in Emergency Medicine. She is the 2016 Tom Ashman PA of the Year Award Recipient. More recently, she advocates for Medical Assistance in Dying in Canada

Follow Maureen on Twitter @maureentaylor31.

This is an edited transcript of Maureen’s Interview with me.

Becoming a Physician Assistant

My name is Maureen Taylor. I was born in Detroit, but I actually spent to 99.9% of my life growing up in Windsor, Ontario. My first career was as a journalist, as a lot of people know, so I spent 25 years, most of it at the CBC but also at TV Ontario. And the latter part of my journalism career was spent as the medical health reporter for CBC, the national, both radio and TV.

And that was where I started to wonder if I’d made the wrong career choice and maybe I should have gone into medicine. And one day this memo came across my desk as a story idea from McMaster about their new Physician Assistant Program. I had no idea what physician assistants were. And rather than do a story on it, I actually ended up applying to the program at the time.

I thought of it as a way to go back to school to learn more about medicine and that would make me a better reporter. I was 48 years old and I took a two year leave of absence to do the program. But when I was graduating I discovered that morale was still really low with the CBC and my friends encouraged me not to come back. So I went out and practiced as a PA and I’m still doing it 10 years later.

What drew me to the PA Profession

Well for me, this, doesn’t sound like a really, a wonderful reason for doing it. But as I said, I actually didn’t expect to practice as a PA. It was a way to get a mini medical education. And for me as somebody with a background in Journalism, History, Political Science, English, I wouldn’t have had the science prerequisites to get into a program like the one at the U of T for example, or University of Manitoba.

So really McMaster’s approach to medicine, the way they approach medical school. And, then the PA school was really the only one that could have worked for me. And at 48, you’re certainly not going to start all over again going back for a science, a prerequisites and trying to get into med school. So that’s what drew me to it.

What keeps me there I think is the idea that I can provide this kind of hands on patient care, very similar to what physicians do, but I do it in conjunction with the entire medical team, and, I really enjoyed that.

“I would  approach my job as I would a journalism story where suddenly I would be handed an assignment and I had to research everything about that particular story that day.”

I would  approach my job as I would a journalism story where suddenly I would be handed an assignment and I had to research everything about that particular story that day. So I know how to go out and research information and gather it quickly and assimilate it. I was never been going to become the expert in that particular, issue on that day, but I can say that I’m becoming very comfortable, at least with infectious diseases now after doing it for almost five years.

My experience being part of the inaugural class at McMaster

It was amazing to be part of that class, I can still see everybody’s faces sitting around during the problem based learning and uh, Dr.John Cunnington, who was just so great to have been able to have him be not only the director of the program, but providing a lot of the learning for us at the time. It was wonderful.

I’m still really good friends with a lot of the people in my class. I just went on a trip to California and Arizona with a few of them. So it’s always, it’s nice to be groundbreaking like that. I think there were hiccups of course that have been worked out since. But those were some good years for me.

McMaster PA Class of 2010, McMaster’s inaugural PA class

Medical Journalism & my PA Education

“Let’s put it this way – asking patients, personal and uncomfortable questions is not a problem for me. I mean, that’s what I did as a journalist.”

Let’s put it this way – asking patients, personal and uncomfortable questions is not a problem for me. I mean, that’s what I did as a journalist. So I think that I have good communication skills.

I deliver news to patient both bad and good news, in a way that’s accessible to them because I always had to do that as a medical reporter.

I had to take complicated studies in journals and then break them down into bits and pieces that an audience would understand. So I think that that’s all good.

I’m used to working as part of a team because especially in television journalism, you’ve got a camera man, you’ve got a producer, usually maybe a writer on the national desk. You’ve got an assignment editor. So you’re all trying to work together to make the best story possible within a deadline. And that’s what we have to do as well as PA’s.

What is a PA?

I tell people, that Physician Assistants are like the residents who never go away. So that’s really works well with physicians and nurses and other people in the healthcare profession. You have to massage that a little bit for the lay public who may not even understand what a resident is at the end of the day.

But when you think about it, and I’ve been told this by physicians that I’ve worked with in both emergency medicine as well as ID, that we reached the level of a senior resident, a very senior resident. And what’s nice about it is we provided those physicians that we work with  that continuity, and they can teach us  like they do residents. The main difference is that residents leave after a few weeks, while PAs stay on on the service.

What we also provide the physician with is a PA who can say, “Oh yeah, I remember you taught me how to do that. I know how you like the neuro exam done. I know how you like your documentation.And so they can rely on us to provide that continuity of care with their patients as well. So that’s how I explain physician assistants to the public.

Sometimes you have to tell them we’re like nurse practitioners, but we’re trained more in the medical model that physicians are.

I have to say that in the last two or three years when I just say I’m a physician assistant, I really don’t get patients asking me what that is anymore. They’re just happy to see me.

Describing the Attributes of an Ideal PA

Well, obviously empathy for the patient and putting patient-centered care first.

You have to be able to think on your feet and have a good sort of general knowledge of pathophysiology. And that goes without saying, right?

Every healthcare professional should have a good knowledge of what it is they are practicing. But I think even more so for PA’s is we have to know what we don’t know and when to ask for help.

“The nicest thing about being a PA for me has been to see and acknowledge that I’m growing all the time and I’m becoming more confident all the time.”

The nicest thing about being a PA for me has been to see and acknowledge that I’m growing all the time and I’m becoming more confident all the time. And it’s great. We generally get residents, we call them fellows in Infectious Disease who come through and I then treat them as my staff for a little while and report to them.

And I think they’re always surprised at how much I already know about infectious diseases. And I certainly know as much as most of the general medicine residents who come through. Who would have thought that about me? 12 years ago if you’d told me that I was going to be practicing at that kind of level, I would have told you that you were crazy.

I wake up and wonder if this has all been a dream.

My First PA Job

My first job was at Sunnybrook Hospital in Toronto in the emergency department.

Three of us from McMaster were all hired at the same time. And we were lucky in that there was already an American trained PA there. So the ground  had been set.

The physicians in the ER had already known what a PA could do. And I have to say I worked with about 30 different physicians. Everybody bought into the PA role and there was never any issue.

We had some issues with nursing at the beginning, but  I always approached that as I let them know right off the bat how much I respected what they brought to the table. And I wouldn’t say I was 100% great with everybody, but I know that many of them became my friends and respected what PA’s do.

And I have to say now that I’ve moved to different position, and there were many PA’s there before and I think we’ve really paved the  for the PA’s coming after us and that these things are not so much of an issue as they were when I first graduated.

What I enjoyed about Emergency Medicine

I loved the fact that in ER  I saw a little bit of everything and honed my skills procedure wise.

I was in a big academic hospital, so I had to acknowledge that there were residents who also needed to get there emergency skills up to bat. So did I ever successfully intubate anybody? No. Did I try a couple times? Lumbar punctures? I did suturing. I became very comfortable with, and helping to set fractures and, put casts on and so on.

I liked that fact though that you saw the gamut from things that were rather trivial to things that were really, really serious. And we were a trauma hospital as well. So we got to look in on some of that.

What I didn’t like at my age was the hours and that was really what started my decision eventually too. I was going to have to get out of emergency medicine. Whether an opportunity came along or not, it [working in ER] was really getting to me, I’m not a good sleeper at the best of times. So to ask me to come home at eight o’clock, in the morning and go to bed and get eight hours sleep, that’s not going to happen. Those were the things that I liked and didn’t like about it.

Working in Infectious Disease

How I came across this PA position

It was so serendipitous. I remember meeting another PA, Melissa Decloe at the CAPA Annual Conference and I found out that she worked in infectious diseases. So just a little background, my late husband was a microbiologists and infectious disease doctor and he and I would talk about infectious diseases at the dinner table all the time. And I always as a reporter, because I covered things like SARS and H1n1 flu, I always liked infectious diseases.

When I found out she had a job, and I’m like, how did you get that sweet job? And she said, I know I have the best job in the world. So that was in the back of my mind and just wishing that some other ID physicians would want a PA and she called me up and said, “I’m going on maternity leave”. It was her first pregnancy and she said they want to hire someone to fill in on my mat leave.

And this was at a time where I was back at SunnyBrook, emerge part-time but still doing the odd evening and night and wanting to find something that was better for my lifestyle. And I was in a position where I could take a chance on a job that might only be a year long. That didn’t really bother me. So I went over to do her mat leave and we had talked, Melissa and I about when she came back, maybe we would even be able to job share, which would have been fantastic.

Melissa moved Ottawa during this pregnancy and she’s up there now, and so she never did come back. I’ve just stayed at the job full time and now it’s almost five years.

Describing the Specialty of Infectious Disease

When people are admitted to a hospital for whatever reason, they’re admitted under different hospital services. And sometimes they have infections as the reason they come in, or sometimes they come in for some other reason – and then an infection becomes an issue in the hospital. So that is when  consult the infectious disease services.

So infections include everything from flu, to a wound infection after surgery to pneumonia, to a gastrointestinal issue.

We deal with a lot of abscesses. You’d be amazed at where pus collects in the body and  has to be drained and treated with antibiotics.

“We deal with a lot of abscesses. You’d be amazed at where puss collects in the body and has to be drained and treated with antibiotics.”

And we manage a lot of the antibiotic use in the hospital because as many PA’s know antibiotic resistance around the world is becoming a huge problem.

We encourage the physicians in the hospital who may be putting their patients on antibiotics to get the Infectious Diseases service involved because we can help select the best antibiotic and the one that will do the least amount of damage as far as promoting resistance.

When to refer to the Infectious Disease Services

You know, I would challenge the premise of the question off the bat because what I’m finding is as medicine gets more and more specialized and as resistant organisms take over the normal flora in our body, I think a lot of physicians are not comfortable coming up with an antimicrobial regimen for their patients. General internists are obviously  very comfortable, but as surgeons for example, they have a lot to think about as far as just managing the surgical aspects.

And then when they find out their patient’s knee swab is growing, something that usually comes from the colon, it’s just easier for them to contact the Infectious Disease specialists in the hospital and say, “what do you think this patient should be on and for how long and what else do we need to do?” So that’s what we bring to the table.

The duration of antibiotics is an issue. Sometimes people are left on way too long. And then there’s the other issue of source control. So if you have an infection of a prosthetic knee, it’s not just a matter of leaving that hardware in and putting the patient on Keflex for three weeks.

It may require you to remove the hardware, actually put in a spacer, leave the patient on antibiotics for three months and then bring them back to the ER to put in a new prosthetic. And  this is where I think Infectious Disease and surgery, in that example, can work together to promote better outcomes for patients over the long-term.

Conditions we see in Infectious Disease

Well, obviously one of the big ones I’m in hospital acquired infections in hospital has been C. Difficile and that’s become sort of a side specialty for me because I actually do the fecal transplants in the hospital for people with refractory C. Difficile.

I’ll give you an example. This week we had a patient who had had a benign liver cyst for years that was just found incidentally on a CT scan and it was being monitored  every few years with another CT, and it wasn’t causing the patient any issues. But all of a sudden the patient was experiencing abdominal pain, and when they redid the CT, it had grown huge. It had practically taken over the patient’s liver and they were febrile. So the  Infectious Diseases Service got involved because of the fever and sure enough that benign cyst had become infected and now it was an abscess.

“I really enjoy those sorts of cases because the mystery is what is the infection and how did this become infective? Where did the bacteria come from? So we sit around a lot and discuss the pathophysiology of how infections happen.”

I really enjoy those sorts of cases because the mystery is what is the infection and how did this become infective? Where did the bacteria come from? So we sit around a lot and discuss the pathophysiology of how infections happen.

To me, that’s like playing detective again and I love that aspect of it. And then there’s just the regular old, you know, diabetic foot, or a  cellulitis vs. chronic venous stasis. I enjoy seeing those cases.

Treatment of C. Difficile

C. Difficile is an infection that mainly happens  in the hospital, but it’s starting to be seen in the community. And it usually happens when you’ve been put on antibiotics. Antibiotics there to destroy the bad bacteria, but as I tell patients in a very elementary way, they also destroy the good flora too. And when they do that, it allows C. Difficile to take over in our gut and it causes this profuse watery diarrhea.

And sometimes very ill people can die of it. And we’ve seen that, it was a huge problem in Canadian hospitals back in the early two thousands. And I don’t think anybody realized how easily it spreads around the hospital.

So there were drugs to treat it at first. Metronidozole and  unfortunately its starting not to work so well for those with more severe disease. So we treat them with Vancomycin, but some people keep relapsing anyway.

We know that about a third of people will relapse. And of those who relapse the first time, about 50% will relapse the second time.

Fecal Transplants: 

So I don’t know who the first one was to try this. It was actually done in ancient China. But by taking the stool from a healthy donor and transplanting it into a patient with C. Difficile, we can repopulate their gut with good bacteria. The way that we do it is through a simple, rectal enema-like, I was just very done in 20 seconds and it’s over.

So when I came to Michael Garron Hospital, the Infectious Disease physicians were already offering fecal transplants to their patients. And I expressed an interest in this because I’d actually done a story about it as a health reporter, and won an award for that story. I told them I’d like to get involved.

An article Maureen Taylor collaborated on with Dr. Jeff Powis and Janine McCready on C. Difficile for

These are usually done on an outpatient basis and I don’t really see patients as outpatients in their clinic, but I wanted to get involved. So I became the one to make the poo. And at first we had a blender for it, but now I have something way more high tech that just involves a styrofoam cup and a popsicle stick. And then I went from mixing the poo for the service to actually performing the fecal transplants. Dr. Jeff Powis, my supervising ID physician and I are probably doing maybe up to 60-70 a year. We get referrals from patients all over Ontario because this isn’t offered in very many places.

And it’s really gratifying to see patients get better with the fecal transplant. One of my jobs is to spread the word and to show that it’s not that hard to do. We’ve been contacted recently by an Infectious Disease physician and his team in, I think it’s the S,u and they want our protocol. They have us helping them set up a program there. So that’s really gratifying.

Day in the Life of an Infectious Disease PA

Well, I work with three different Infectious Disease doctors and  they all rotate one week. Every three weeks it’s back to the other doctor again. I really enjoy that.

When I get in, in the morning, the first thing I’ll do is I’ll look at the new consult list (as we call it). So has there every patient that any physicians has consulted the ID service overnight or early in the morning and how many new patients there are to see. And I will usually get started with those. And then when I see them, I do all the research.

I may be order some extra tests if they’ve already been started on antibiotics. I make sure that it’s the right one and I might go see two or three of those.

And depending on how they like to work, I sit down with the Infectious Disease physician and we talk about the patients I’ve seen. Ten we go see all those new patients together once and we put a plan in place for those new patients.

Then we have our followup list. So when we see these new patients, it’s not just a matter of seeing them the first day and then signing off. Some of them need us to follow along because there might be outstanding tests  and investigations such as microbiology (C&S) and imaging. So these new consults become my followups as well.

And I spend the rest of my day going to see my followups and writing notes and let’s face it, I spend a lot of my day writing dictating notes and that’s a complaint of a lot of people who work in medicine. Now, we seem to be quite tethered to our computers and not really spending as much time with patients as we would like.

My day is about is usually 8:30am to 5:00pm or sometimes a little bit later.

The PA/MD relationship

We have the kind of relationship where we’re in constant contact with each other anyway and by text. Even if it’s like, do you want a coffee, you know, this morning. So I feel very comfortable, changing some patients, antibiotics, but others, I feel like I want to chat with them first. But it isn’t even a chat. It’s like, can I change that Ertapenem to Pip-Tazo? And often the physician is already looking on the computer themselves at the new patients’ files. So we’re totally in sync. It isn’t the kind of thing, like they’d never said to me, “Maureen, I don’t ever want to see you stopping the antibiotics until you talk to me.”

That’s not, it’s just kind of evolved gradually. As I gained more confidence, knowledge and skills, then I do more things independently. But also, as I gained more confidence, it hasn’t stopped me from being able to consult them when I just want that second opinion and that is a blessing. I actually feel I have as much autonomy as I need and that’s because I have a great relationship with all the doctors that I work with. And that is also because the PA  (Melissa) who came before me had already laid that groundwork for me.

The three physicians I work with differ in that, one of them likes me to let them know when I’ve seen a new patient right away because we call those the one offs we want it. He would rather hear about the new patients as I do them through the day because he has so many other responsibilities in the hospital. Whereas a couple of the other doctors that I work with, they’d rather I see them all in the morning, have lunch, and then let’s sit down at one o’clock and let’s go over everything all at once.

“I actually feel I have as much autonomy as I need. And because I have a great relationship with all the doctors that I work with.”

So it’s kind of like a Bolus of patients and followups at one o’clock. And then we go around rounding on them all together and then I get back to my desk and I can dictate all my notes. So it’s just, it’s just how they prefer to organize their day and it really doesn’t have anything to do with them. Not trusting that I haven’t done something right in the morning, you know what I mean? If it’s, it’s physician preference.

Interacting with RNs & other health care providers

Working with nurses and other health care providers is absolutely great! And I have to say that because I’m a consulting service and I don’t really have to hang out in a specific ward all the time. I’m all over the hospital from the oncology ward, to respirology ward to the emergency department. But we have PAs in our hospital who are in internal medicine and basically spend whole days on those wards and those nurses on those wards already are used to the PAs interacting with them and helping them.

With nurses, I often spend more time talking to them about “what did the bowel movements look like this morning? Did this patient have a fever this morning?”

And I don’t really have to instruct nurses to do something because it’s all orders are done electronically.  So if I want an antibiotic stopped and another one started, I put that into the system and it comes up in their system and they implement that order.

This is the same Personal Support Workers (PSWs), Registered Practical Nurses (RPNs), in addition to the Registered nurses we work with. I also work with physiotherapists, social workers, and occupational therapists. But this idea of will they take orders from me is not an issue in our hospital because of the electronic record, but also because of the hard work that’s already been done to help all of the other allied health understand what PAs do.

Tips for Hospitals on Integrating a PA

Q. Any tips for hospitals that are looking to integrate PAs on how they can foster that kind of environment?

A. Only in that, you know, do some education ahead of time, encourage allied health to talk to their friends and colleagues in other hospitals where there are already PAs, show them the data that shows that PAs don’t actually take nursing jobs. Like there’s absolutely no evidence that we’ve taken away nurse practitioner or nursing jobs and if you talk to a few who’ve had them for awhile, I think they’ll tell you that, “oh my God, I love having the PA because I can never reach the physician, but I always can reach the PA.” So that’s what I would do.

What patients can expect from a PA in Infectious Disease

I mean, I think that they can expect two things. They will see me almost every day and follow me along, but they will also, have met the physician who supervises me. So that’s something we always do on the first day. The physician will be there to answer their questions, but they know that when they see me after that, if they have a question that I don’t have the answer to right off the bat, I’ll speak to my physician and get back to them.

A lot of times they will ask me questions that have nothing to do with their infection. A lot of times it’s, “and so do you think they’re going to take the gallbladder out during this admission or are they going to make me wait?” And I explain that I have no idea and have no control over that. So a lot of it is just educating the patient about what I can do, what I have control over and what I don’t. Because remember we’re seeing patients, yes, for their infection, but sometimes that’s not all that’s going on with them. They have a lot of other reasons to be in hospital.

And then one other thing I want to add about me that’s maybe different from other PAs as I do in infectious diseases.

You wouldn’t think we see a lot of patients who are palliative, but sometimes we do see patients in that transition from active treatment to palliation and they may have an underlying infection going on that has nothing to do with whether or how soon they’re going to die. I let them know that I’m okay to talk about their death and their goals of care and things like that, even though it’s not really my bailiwick.

If they have questions around that, because I have an interest in palliative care in and dying, I let them know that it’s okay to talk to me. And you can talk frankly to me about your fears because I’ve been there myself. And so maybe that’s something that I’m adding to my practice that really has nothing to do with my role as an ID/PA.

Benefits and Challenges of Working in Infectious Disease

Yeah, as I said, I do enjoy figuring out how this infection came to be for things that aren’t obvious. There’s epidemiology involved sometimes. So, you know, especially in the hospital when we have an outbreak on a ward trying to track, I don’t have that much to do with that sort of thing, but my bosses do. So I listened in on that and that’s, that’s fun. I obviously enjoy  the part where we tried to choose the best antibiotic with the narrowest spectrum.

If people know what that means, because otherwise, why not just put everybody on Ertapenem? But there are good reasons not to, and I take cost into consideration as you know, I have a long history of supporting a universal healthcare system in Canada and I know that this is in jeopardy, that we’re not going to be able to afford it if we keep going at this rate.

So I’m a big fan of Choosing Wisely. So that’s what I enjoy.

Following Infectious Disease topics onTwitter 

Twitter is great. So what I do is I follow journals and infectious diseases and I follow a smart micro ID people and when I wake up first thing in the morning before you even get out of bed, I’m running through the twitter feed and if there is an article that I think I need to read, I flag it for later. So I say that’s mainly how I stay on top of things. But also, you know, we’re able to access grand rounds in ID throughout Toronto. So we try to make time in our busy day on Tuesdays to do that. But it’s hard. Yeah. And then just in talking to my physicians about these things all the time.

Tips for PA students studying Infectious Disease

So this is what I tell the students who do come to me and seemed scared because I know how little you get in ID in your training. I don’t expect people to, know antibiotics. So right off the bat that’s, that’s not going to be their job. But I would like them to know the difference between for bacteria anyway, gram positives and gram negatives and just be able to name a few. Right, that’s fairly easy to get through viruses you’d be surprised, we don’t actually in hospital end up treating viruses as much as we end up treating bacterial infections. That’s just because there’s not that much for viruses. Right?

A lot of time it’s just supportive care. So I tell them, don’t worry too much about viruses, but bacteria gram positives and gram negatives and come prepared to name a couple and the diseases that they cause. And I think from there you’re going to go out and see patients on your rotation and it’s slowly going to dawn on you. Which ones that are kind of like, we call them above the waist and which ones generally below the waist. That is over simplifying, but it’s certainly enough for a student to get started.

The Impact of Adding a Physician Assistant to an Infectious Disease Service

This is all the work done before I got there by Melissa and the team. But they actually look at the data and collected the data, and I’m not going to know the study as well as Melissa would, but the gist of it was that they could show that when they got the PA in ID, the patient time of admission and the time to being discharged home was decreased by, I think a couple of days at least. And this is the physicians will tell you in plain language before they had a PA, physicians would put in an

Commentary on the Effect of a PA on an Infectious Disease Consult Service

ID consult and it might sit there more than a day before they could get to your patient. So this is one extra day of you maybe not knowing whether to start antibiotics, which antibiotics to start, right? But now with the PA that never happens.

We’re able to see all of the consults if they come, you know, that come in between eight and five 30 at night and you know that we’re going to come up with a plan by the end of that day for your patient.

And I think that by having a PA on, the way, the reason they were able to get them out of hospital quicker is we come up with a plan for what are you going to go home with an IV in a PICC line, “who’s going to follow you up? What imaging are you going to need?”

And I helped arrange all of that. So I think that those are the reasons that I know that if I had to quit the job tomorrow, they would definitely be advertising for another PA to take my place. It’s the kind of thing that they’ll never be able to live without now.

Working with Residents

We actually don’t have as many residents right now as we used to, but when we had the fourth year general internal medicine residents, I would say to them, you know, if you have anything to teach me about, especially patho physiology and stuff like that, I’m happy to learn. I used to say that more in the beginning than I do now. Now when I work, the people I work with most, from time to time, our fellows in ID. So these would be our fives basically. So they’re already very knowledgeable. They’re about to write their royal college exam. They are up to speed on all of these drugs and bugs and everything. And so I learn from them. I don’t have the clinical clerks and medicine or the R1’s that I have to teach, but I do get PA students obviously.

Change in Scope of Practice

There was a  very obvious change in scope of practice when switching PA jobs, especially starting off in emergency medicine that you weren’t going to be able to walk in the door right after graduation and be able to start, ordering imaging. Like you’re not going to be able to order an MRI or a CT with contrast right away. I mean those are things that you want to be careful and know what the right indication is. And then all the PA students when they graduate, they want to know what procedures you’re doing. Like everybody has very procedure oriented when they come out of school. So it’s going to be gradual.

The physicians are going to have to watch you do a couple and then they’re going to be comfortable letting you do it. We didn’t at SunnyBrook, have official sign offs. Like I need to see you do three and then you can do one alone. It was just sort of a discussion between you and the physician. But your scope of practice definitely grew as you gained more experience and more confidence.

Now I’m over in Infectious Disease and really for me what would be a little beyond my scope of practice would no longer be, am I going to put a chest tube in because I’ve got to tell you I don’t do that. We have people way better at doing that. My ID physicians don’t do that. The procedures that we do, we might do a little abscess draining here and there and then I guess obviously the fecal transplants. But for me, scope of practice would be, when am I going to be able to be confident enough to know when we have to pull out Ivermectin for example, or Colistin, which is the antibiotic of last resort and is terribly toxic, you know, so we have ID pharmacists we work with as well.

And what I noticed with my physicians is they wouldn’t even start those things without first talking to the ID pharmacists and discussing, yeah, do we really want to pull this out? What do we got to look for? So that’s scope of practice in the ID world, which students are probably listening and going, well that’s kind of boring, but really for me it’s not. Those are, those are the exciting things. So scope of practice hasn’t really, is not as much of an issue for, I think, someone in a consult service like me as it would be where you’re doing a lot of procedures in like an emergency medicine scenario.

Steps to Hire a PA in Infectious Disease

My boss, having already had Melissa before me, told me that he would like to send me to our microbiology lab, which has way uptown, for a week of just watching how microbiology works at the bench side. So I went for a week and watch them, you know, take the plates with the agar and put the specimen on it and put it in, you know, the different machines that they have and how they get answers.

I have to say in retrospect if they have to do it over again, I think I went too soon, I had really just started. And what would probably have been better would be for me to become more familiar with the different, organisms that we would be dealing with and the different antibiotics that they use to see what susceptible and what’s not. Because that’s how you find out what’s resistant and then go. So it almost would have been better a year into things. So that would be one thing. Yes. They, they’re going to need to learn more about microbiology.

But first give them some practice just with the simple kinds of infections that you’re going to run across in the hospital and get comfortable ordering the drugs. It was a long time before. Like now I don’t have to look up the dose for very many antibiotics anymore. They are there.

But if you ask me now what dose we used to give even for, you know, tylenol threes when we send people home, I don’t know if I remember that. It’s amazing how the brain takes out the superfluous information that isn’t needed anymore. Cause I don’t order Tylenol for people anymore. So, that’s what, I would say to them, your PA, it will take time, but eventually they’ll get very comfortable doing that.

And I can’t reiterate enough, if an Infectious Disease doctor has ever had a resident like an R4 who really took to ID and they were wishing they could stay around because it was so nice having them see patients and making your life easier, that’s what a PA could do for you.

So I would encourage, and that’s really all there is to it. It’s not rocket science.

Working with Medical Directives

Yes, we have medical directives and the ones in ID have just been adopted from the ones that were already done for the, general internal medicine, PA. So we just have a few days. Obviously the drugs would be different and we updated them a little while ago and that’s actually the last time I had to look at them.

Working in Research

I’m lucky in that the physicians I work with do, do some research. I wouldn’t, we’re not like one of the downtown academic centres where we’re involved in trials all the time. But they do do some, I’m a bit busy to be involved in all of it because, you know, my primary job is seeing the consults in hospital.

However, there was an issue where one of the ID doctors, Janine had talked our boss Jeff, into a trial where we looked at whether dogs could successfully be trained to smell C. Difficile. And we were thinking of this as a way to diagnose patients earlier because I don’t know if you know this, but once you collect the specimen and send it to the lab, it can take 48 hours to get a result. And in the meantime you don’t know should this patient be in isolation? Should we start Vancomycin, should we not?

Maureen’s Feature in

So Janine started the whole thing, found the dog trainer who found the dogs and they were starting just practicing in the hospital with specimens and going into real rooms. And then Janine, when they wanted to start the actual trial. Janine was on mat leave, her baby came early. So Jeff turned to me and said, “Maureen, I’d like you to take over. You’ll be the principal investigator, you’ll run the trial and then you’re going to write the paper”.

And this was amazing for me because I have written other papers that have been published before, but they’ve all been qualitative things, which more fits with my background as in journalism as a journalist. But this was quantitative data. And although I had lots of help, it was a great experience for me to run that trial and get it published in an infectious disease journal just a few weeks ago.

The final result, just to give it away as, the specificity and sensitivity are not bad, but the dogs did not have great inter-rater reliability. So probably not a way to go in the future.

Other Advocacy Initiatives

When I was one of the part of the graduating class, I saw myself as an advocate for the new PA profession, but now I think there are better people to do that now, younger people who are carrying that torch.

And because my late husband, Don Low died of a brain tumour in 2013 occurred around the time when the supreme court in Canada had not yet ruled on the legality of assisted death. And, so it’s a lot of people know that I’ve become an advocate for assisted death since then. Don died with palliative care and, conscious or sorry, yeah, palliative sedation, which was not how he wanted to die. So I  made it one of my goals to see it not only legalized in Canada, but accessible.

I would say that, what we’ve had it for a couple of years now, things are certainly better and I’m really grateful we have the law, but you’d be surprised how many glitches there still are, not the least of which is people being able to access it in some religious hospitals and religious nursing homes and things. And just the whole idea of whether you should be able to use an advance directive to ask for Medical Assistance in Dying (MAID) as we call it now should you get a disease like dementia.

So I’m still doing a little bit in, in that front, but to be honest, the Infectious Disease job as a PA keeps me very, very busy.

I’m 58 now and I kind of am thinking of how I’m going to sort of wind things down maybe in three, four year – when my kids are finally launched and don’t require me as much anymore.

I’d like to, my goal would be to work part time  in a job share in Infectious Disease and thenwind that down to retirement and do more travel.

What I use social media for

It’s hard to describe twitter to people who just think they’ve scrolled through it and don’t understand it.

There’s a community of people fighting for  MAID (Medical Assistance in Dying), and we follow each other. Even people in Australia and England and Australia, right now they’re back where we were five years ago on the topic of MAID, where I was just starting on that journey.

So I’m in contact with those people, not providing them with anything important but mostly support and letting them know, “keep at it, it’ll happen for you. It was like that for us”.

So there’s Medical Assistance in Dying, there’s the medicine –  infectious disease, and then there’s journalism. I still am interested in how the world works and especially politics in Ontario as it pertains to healthcare. And for all of that, there’s that community on twitter. People I agree with and don’t agree with. My kids are very impressed by how many followers I have.  That’s how I use social media to stay connected, to stay on top of things.

I don’t use Facebook often – it’s not where I put my personal life out there.  I’m not somebody who’s going to go on a trip and post a lot of photos for people to see and I’m never going to use twitter for that.

I consider twitter more professional and I actually following people who do too much about their personal life, although a little bit of is okay, but not too much.

And then Instagram is where I’ve see what my kids have been up to in the last 24 hours. So I like Instagram for photos, but, but I don’t use it very much for, you know, medicine and advocacy in that way.

Following People, Not Hashtags

The other thing about me on twitter is that  I’m not a big hashtag follower. I’m more a person follower. I tell my students when I do one class at McMaster’s PA program Professional Competencies Class on this issue, I tell them that you should be following Andre Picard, and other health journalists like Kelly Grant,  and Kelly Crowe from CBC.

Maureen Taylor receiving her award for the Tom Ashman PA of the Year at the Annual Canadian Association of Physician Assistants conference