John Bielinski, MS PA-C 
I was fired from my job as an EM physician assistant after just a year. It was my first job after I graduated from PA school. I was called into the office by the emergency department director and nurse manager and told to find a new job. It was explained that if I left quietly, they would give me a good reference. However, if I made it difficult, they would fire me and not give a good reference. That was absolutely devastating; it was one of the worst things that had ever happened in my life.
My problem was not medical. It was social. I brought a military attitude into a civilian emergency room. I upset key people in the hospital: doctors, consultants and nurses. That spilled over into patients’ experiences. I thought that if I worked hard, came in early, stayed late, and studied, my work ethic would make up for my lack of social skills. Well, that thinking got me fired.
I blamed a lot of people for this, including the doctor I upset because I called him out for being lazy; the charge nurse that was “out to get me”; and the head PA who criticized my performance. It took me a few years to realize the situation was not anybody’s fault but my own. I created my own problems.
When I realized this, I became a student of human interaction. I began studying leadership, human interaction and emotional intelligence. I read books (Dale Carnegie and Stephen Covey were my favorites), went to classes and took seminars. I became a lifelong student of human interaction.
I’m sharing this with you because of the executive MBA program I attended at the University of Buffalo. The program included a mandatory course that spanned all four semesters. It was not accounting, business organization or economics. It was emotional intelligence.
This MBA program knows how critical it is to teach executives how to interact with people. There is good science behind this; enhanced human interaction skills are needed to succeed in today’s business culture. I combined the principles I learned during my years as a practicing PA and the material I learned in the MBA program to create a format designed for medical professionals.
You need two key components to be an expert in your field of medicine and provide excellent care. These two components are equally important and they balance out:
- Medical knowledge
- Likability and effectiveness
We will start with medical knowledge, but first I need to ask you a question. What makes an expert? What makes one person an extraordinary provider when the people around them are only average? What factors decide who is an excellent physician, physician assistant or nurse practitioner?
I will give you three options to choose from.
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- Education, such as where they went to school.
- Experience, including where they worked and how long.
- Domain-Specific Training, which reflects classes attended and courses taken.
Which of the three is most important for an “expert”: education, experience or domain-specific training? All of these factors contribute, but they aren’t the deciding factor. An expert provider practices “metacognition” or a learning philosophy known as “deliberate practice.”
Metacognition has been studied by evaluating different groups of experts, including chess players, musicians, professional athletes and physicians. Who gained knowledge the quickest and most effectively? Those who learned through metacognition, or evaluating their own thinking. These experts ponder about weakness in their practice and how to fix it. They constantly reflect on their practice. They goal set and are courageous in taking on new challenges.
Where are you weak? What patients do you avoid because you are uncomfortable with them? Those are the people you need to focus on. Why are you uncomfortable with them? What clinical skill set do you need to feel more comfortable with them? Those are the knowledge areas you need to focus on.
When I started working for a regional stroke center, I had a difficult time making clinical sense out of the neurological exam. It really motivated me to learn neurology. Metacognition is the key to your professional growth.
I challenge you to research this concept independently.
Let’s move on to the other side of the balance; equally as important as medical knowledge is likeability and effectiveness. If you have a lousy bedside manner, you won’t do well, especially as a mid-level provider. You can be a brilliant clinician, but if you upset your patients, they won’t listen to you.
If you upset the consultants, they won’t want to help you. You will have a very difficult time if you upset a consultant and then have to interact with them again. Who ultimately suffers? Your patients. I am speaking from experience.
There is something I call the “intelligence to ego,” or “I:E,” ratio. If you are very smart and you have a very big ego, you will do fine in medicine. If you are not very smart (or not very experienced) and your ego is low, you will also be okay. You will frequently not know the answer, but you are humble enough to ask for help. However, when the opposite happens, and your ego is high and your intelligence (or experience) is low, that is when you make bad decisions. That’s when people can die.
I want you to ask yourself, how is your I:E ratio?
