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First Year PA

Holes in Our Armor

Published July 25, 2013 3:41 PM by Harrison Reed
At the risk of sounding arrogant (my close friends are shaking their heads and thinking, "That ship has sailed, Harrison...") I must confess something: I haven't made a lot of critical mistakes in life.

I'm not saying I am perfect. I am light years away from that. But if you had to write the tagline for the story of my career thus far, it wouldn't work as a long-shot-comeback or a gritty tale of redemption. For whatever reason, I have avoided the minefield of pitfalls that often delay, sidetrack or otherwise curtail professional progress.

Unfortunately, that also endowed me with a massive flaw. When it comes to the development of certain skills, I have to admit I am late to the party (and not in any fashionable way).  You see, I am still learning how to deal with setbacks. I am figuring out how to step back from a situation, examine why it doesn't work and attack the problem in a different way.

Through much of life we can rely on our strengths to compensate for our weaknesses without ever really addressing them. But medicine has a way of exposing those flaws anyway. The difference between success and failure is not a matter of how many flaws we have, but what we do about them.

The last 6 months as a PA-C have shone a spotlight on every hole in my professional armor. And sometimes I feel less like a clinician and more like a slice of Swiss cheese. For someone who has cruised past a lot of speed bumps in life, that is pretty terrifying. A part of me wanted to run and hide from the adversity that a new PA faces every day.

But none of us chose this career because it sounded easy. And every screw-up sears a vital lesson into my brain. The hard-knock education that life delivers is the difference between knowledge and wisdom. One you can acquire with training; the other just happens over time.

I'm lucky enough to be surrounded by people who care enough to give me direct feedback. Their only agenda is molding a good clinician. If you find those people throughout your career, keep them close. Often, your flaws-those holes in your armor-are better seen from a distance.

It's tempting to look upon your own shortcomings with a sense of disgust. Some people carry their mistakes as a lifelong burden, as evidence that they aren't good enough for their relationships or their job. They see the holes in their armor only as an imperfection and not an opportunity.

But you know what else is full of holes? A sponge. And one thing a new PA can do is use those flaws to soak up every bit of knowledge and wisdom that comes his or her way. Because the only thing worse than making an error is missing the lesson that it offers.


I have just graduated this past May as a family nurse practitioner. I have been a RN for twenty years.  I am taking my boards next week and then hoping to find a good job soon thereafter. I understand your point of view as a new clinician--you feel humbled by the knowledge and experience of those around you. But, we all need to start somewhere. I remember feeling terrified as a new nurse until I had a wonderful charge nurse who mentored me and nurtured me until I was strong enough not only to fly on my own; but now to instruct nursing students. I pass onto to them the many invaluable lessons that I learned and recall how I felt like I "died a thousand deaths," because of my lack of confidence as a new nurse. To compensate for lack of experience, I looked up things more and sought counsel from those with more experience. I think that I will be doing the same as a nurse practitioner until I feel seasoned enough to trust my own judgements. Having earned a Master's degree after being out of college for twenty years has reinforced that lifelong learning is the key to keeping up, and that no matter what--no one knows it all. That's why it is important to work in a setting where I can feel free to collaborate and ask questions without feeling demeaned. A safe practitioner takes constructive criticism and becomes a better clinician for it. The arrogant new clinician who thinks that he/she knows it all and does not want to hear from someone with more experience is the one that frightens me and is headed for disaster. We have to walk that fine line of having confidence in our knowledge and abilities and yet be humble enough to realize that we will in some sense be life-long students.

Bradford Arlene, family practice - MS, RN, N/A August 1, 2013 5:48 PM
Riverview FL

As a new PA you have NO armor.  In fact, you don't even begin to acquire armor until you've been seasoned for a number of years. Your sponge approach is much more appropriate and will go a lot further with your physicians and PA colleagues.  And, the only one(s) of us who doesn't make mistakes is a fool.  Just remember the medical montra - "first, do no harm."

Tony Bevill, , MPS, PA-C/EM Med Ctr Central Ga August 1, 2013 12:11 PM
Macon GA

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