My Scope of Practice: Giving the Gift of Time

Time discovers truth. – Seneca (philosopher, mid-first century AD)

  A physician’s assistant specializing in urology, Esther McCorkindale, PA-C, believes the key to providing good care is time – most importantly, the time to listen. Recently recognized by the National Association For Continence (NAFC) as a Continence Care Champion for her significant commitment to education, her dedication to personal academic growth, and her facilitation of peer advancement, Esther advocates for instructional opportunities for providers and patients. She also recognizes that quality of time equates with quality of care.

  Interested in a career in healthcare, Esther earned an associate degree in physical therapy. Deciding she “wanted something more medicine-related,” she subsequently pursued a Bachelor of Science in biology at the University of Maryland, continuing her education at the Kettering College of Medical Arts in Ohio and completing an accredited Physician Assistant (PA) program. She worked in family practice for 5 years.

  During a visit to Washington state, she was recruited by several physician offices. “Urology seemed a good next step,” Esther says. Since 2000, Esther has been a PA at Yakima Urology Associates, PLLC, Washington, a practice group that was awarded a Merit of Distinction by the NAFC 3 years ago. “In our practice I am able to diagnose, order tests, prescribe medication, and provide education,” she says. “As a PA, I have the benefit of a physician nearby on site, while my accreditation allows me to practice independently. I treat everything from prostate infection to cancer to stress and urge incontinence to OAB (overactive bladder). Basically, I see everything.”

  Much of Esther’s responsibility involves education – speaking on OAB- and incontinence-related diagnoses and therapies. A lecturer in gynecological and urological pathology in the University of Washington’s PA program, Esther also gives talks to residents in long-term care, mid-level practitioners, nursing assistants, home healthcare workers, and the general public. She finds educating patients on incontinence “especially rewarding” and sees her role evolving to include more education outside of work.

  To keep abreast of the latest medical advancements so she, in turn, can share knowledge with other practitioners, caregivers, and patients, Esther continues her own education by attending training from The Mayo Clinic, American Urological Association (AUA), American Academy of Family Physicians (AAFP), and numerous medical centers that focus on primary care, women’s health, and other important urologic issues.

  Being a woman in a urologic practice has distinct benefits. “Women relate to me, where they may be a little reluctant to be as frank with a male physician,” Esther says. She is grateful her practice includes a biofeedback nurse versed in the EXMI chair, an innovation that helps train pelvic muscles to contract and relax to offset the effects of bladder disorders. On the flip side, she may have to “ease men into conversation.” She has a bargaining point: “I have much smaller fingers when it’s time for a prostate exam.”

  Esther’s patients are referred in or call with their problems. She would like to reduce the number of patients she sees per day because it would afford each patient more time. Esther’s office has been cooperative in this endeavor, giving her free rein with scheduling.

   “The more patients understand about their condition, the better able they are to help themselves,” Esther says. “They are happier, more satisfied with their management, and more willing to follow clinician recommendations for their self care. A woman with increased urinary frequency, for example, may not realize that her problem is a result of the two pots of coffee per day she consumes.” Esther knows that learning about the coffee requires unhurried discussion to reveal habits that may affect the bladder and that unhurried discussion requires time.

  Esther says she didn’t do anything out of the norm to receive her recent recognition. Her patients may say otherwise, appreciating the patience, wisdom, and counsel that allow them to reveal their truths in her scope of practice.

My Scope of Practice is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ. This article was not subject to the Ostomy Wound Management peer-review process.