Each year the University of Washington selects 100 students to become the “Husky 100”, students who inspire. According to the University’s criteria, “the Husky 100 actively connect what happens inside and outside of the classroom and apply what they learn to make a difference on campus, in their communities, and for the future.”
This year, Sarah Larson of MEDEX Seattle Class 51 joins this distinguished panel.
At the moment, Sarah is in her clinical year at MEDEX which comprises the final few months prior to graduation in August 2019. Key to this second year in PA education are rotations at various clinical facilities—hospitals, clinics, and medical offices. What’s apparent is that Sarah has not shirked from some of the tougher clinical placements offered at MEDEX. Among them is a split Primary Care assignment—2 months at Harborview Medical Center in Seattle and 2 months at an Indian Health Service hospital on the Blackfeet Reservation in remote Browning, Montana. Both qualify as underserved rotations, a mission that MEDEX promotes among its students.
“It’s an incredibly beautiful area but also can be a difficult place to be,” Sarah says. “Unemployment on the reservation is about 70%. There are a lot of social problems and you have very sick patients with complex medical and social histories. At the same time, the Blackfeet are a strong vibrant people and who have worked really hard to revitalize their culture in the face of many challenges.”
Sarah is quick to point out the prejudice and policies that negatively affect Native American populations everywhere, and this is evident in their healthcare.
“It shows up in how patients access healthcare and how they trust healthcare providers,” Sarah explains. “There’s a lot of mistrust, especially toward non-native people. And as a white privileged person, that was definitely something I had to wrestle with and think about. What is my place in this community? How to be helpful but respectful—really learn from patients—and not assume that I knew their situation.”
Sarah’s rotation at Harborview Medical Center in urban Seattle offered a kind of mirror image experience to her time in rural Montana.
“It was an amazing rotation,” she exclaims. “I was privileged to work with a very diverse patient population.”
Sarah Larson of MEDEX Seattle Class 51
She encountered many challenging clinical scenarios. Harborview takes patients with very complex disease, also very complex social-economic barriers and life situations. “I came to understand how Harborview captures a lot of the patients that do not receive care anywhere else, especially people who are immigrants and refugees and who are uninsured, undocumented, or homeless.”
For Sarah, Harborview was an amazing place to work in terms of serving the population she’s always hoped to work with.
“I feel like a lot of these patients get missed by our health care system, and I hope to reach those people, help them access services and keep them out of emergency rooms.”
This personal mission is readily evident when you watch Sarah in a patient encounter. She’s really trying to educate, explaining test results to the patient and detailing what is their responsibility in self-care.
“Taking the time to incorporate education has such an impact on the ways patients can have ownership of their own healthcare,” she says. “You have a conversation and meet patients where they’re at. This allows people to get where they want to go and feel empowered about making better choices.“
This all started in 2007 when Sarah, at age 17, shadowed University of Washington Medical Center PA Monica Morrison. “I have a very distinct memory of that experience,” she says.
Monica, a physician assistant in the hospital’s liver and kidney transplant service, was rounding on a patient who had been approved for a kidney transplant. She was performing the final physical exam assessment on the patient prior to surgery—a thorough head-to-toe exam—when she found some lymphadenapothy under his arms and swelling of the lymph nodes under his armpit. Sarah recalls that this started a cascade of events with the recognition that this patient was getting sick.
Monica Morrison, PA-C of UWMC liver and kidney transplant service
“He had an infection brewing and the other providers hadn’t noticed,” Sarah explains.
This very specific exam finding led to this patient not being able to receive a transplant at that time. Performing a transplant on someone who has an active infection presents a huge risk for failure of that transplant.
“You know, Monica took the extra time to talk to the patient and perform this thorough exam,” Sarah recalls. “It showed me the power of what a PA can do and how important they are as a member of the clinical team, and how invaluable they are to the health of patients. I felt inspired by who she was as a provider and that stuck with me. So here I am at MEDEX.”
Sarah got her undergraduate degree in Community Health and Health Education at Western Washington University in Bellingham, WA. Her path to MEDEX included working for a year at a domestic violence shelter in Seattle where she considered the social work path versus the medical field. But for Sarah, all those things were intertwined.
“Health and health education, access to medical services and social services are all components of well-being and health for patients and for individuals,” she says. “I felt like I needed to explore some different avenues, but I was always thinking about medicine, and wanted to make sure it was the right choice before doing it.”
Sarah worked for three years as a medical assistant at a small Seattle-based abortion clinic. “We saw patients from all over the world who had been trying to access abortion services,” she says. There you could find patients in their second trimester from Central America, Europe, Japan, Canada, and all corners of the U.S.
This experience taught Sarah the importance of abortion care and women’s healthcare. “It’s an essential component of healthcare for female-bodied patients, and not all patients who receive abortion care identify as women. It’s an essential part of healthcare that doesn’t have to be so stigmatized. It’s a choice that every individual needs to make for themselves. I felt so honored to be able to help these patients in this moment in their lives at a kind of crossroad. It was filled with many different emotions—happiness and sadness. But as a medical provider, it’s our duty to provide patients with all of the information about what their options are in the face of unintended or unwanted pregnancy. Every individual has their own personal and ethical decisions that have to be made.”
Looking ahead, Sarah has several rotations in her schedule including a return to Harborview, this time in the Department of Psychiatry and Behavioral Sciences under preceptor Marty Buccieri, PA-C.
As she imagines life after MEDEX, Sarah ponders her career as a physician assistant.
“I continue to be drawn back to primary care,” she says. “I think I always have been. And, you know, I think I would love to be somewhere where I could be doing primary care and doing women’s health.”
Ultimately her goal would be to work one day a week at a clinic where she could provide abortion care. But in order to accomplish this, changes need to take place in current Washington State policies.
“If our primary care providers can provide abortion care, it changes the way we talk and think about abortion care. If you could see your primary care provider for first-trimester abortion, it normalizes abortion as a part of healthcare. Abortion clinics play a really important role in abortion care and are an essential component of our healthcare system. But I think it’s important to expand these services, especially to rural areas where there aren’t abortion care clinics.”
In parts of the state outside of Seattle, someone might have to travel a hundred miles for abortion services. “But if a PA in a small rural town can provide abortion care services in the first trimester that can have great impact,” Sarah adds.
Sarah has been working on state policy changes to expand the scope of practice for PAs, nurse practitioners and certified nurse midwives in Washington State. Recently, she submitted a policy resolution to the Washington Academy of Family Physicians (WAFP).
“It’s really important to have physicians onboard, supervising and training PAs to provide abortion care. If we don’t have physicians who will support and educate us, even if the law says that PAs can provide abortion care, then it’s never going to happen.”
Clearly, Sarah Larson is willing to take on a political role as a future physician assistant.
“It’s important that providers understand how changes in insurance, access, payment, and scope of practice laws impact patients on a day-to-day basis. It’s my responsibility as a healthcare provider to be involved in shaping health care policies and laws that improve access and quality of care for all patients.”