Hema Majeno, PA-C

As a PA in a rural area, Hema works with many undocumented immigrants and especially women to build relationships so they trust her to provide necessary healthcare and wellness counseling.

EMPLOYER:

Adventist Health Community Care in Parlier, California

NCCPA CERTIFICATION:

Certified physician assistant (PA-C)

Hema’s blog (below) was previously published in Physicians Practice.

© Physicians Practice 2016

Physician's Quote

“I have worked with Hema for almost three years at Adventist Health Community Care in Parlier, California. She is a very bright, knowledgeable and experienced physician assistant who has a great deal of responsibility in managing a wide diversity of patients from newborns to geriatric patients with multiple medical problems. I am very impressed by her compassion for our patients, her integrity and professionalism. She is a highly committed individual with a good sense of clinical judgment and priorities.” --Rogelio Fernandez, M.D.

PAs Providing Women's Health: More than OB/GYN

By Hema Majeno, PA-C

Having emigrated from India in 2003, I have always been interested in the healthcare of women in rural areas. Today, I am fortunate to work as a certified PA in a family medicine practice, which provides care to many women in the San Joaquin Valley of California.

Women PAs can help to meet the needs of women in rural areas by providing access to needed health programs and services, and offering the opportunity to be seen by a female provider. I think this also increases patient satisfaction as women may be more candid with another woman.

Many of my patients are undocumented farm workers, who are dealing with language and cultural barriers as well as raising their children and trying to keep them in school. While the demographic base of my practice may be different than yours, by and large women's health needs are universal. It is important to treat the whole woman, not just today's problem. This includes not only preventative physical exams, but also screening for mental health.

Most of my patients come to me through word-of-mouth referrals and I usually see 20 patients a day. Typically, a woman will come in because of symptoms, like a cough or cold. While I handle the acute problem, I also use the opportunity to ask if they have had a Pap smear or a mammogram and try to schedule a physical. I want to have more time to do a total assessment: check for cholesterol, diabetes, hypertension, and more. Many of my patients put their families first and have neglected their own health for years. Of the 45 minutes I schedule for an exam, I spend at least 20 of those minutes on preventative education.

However, my goal isn't to just to provide acute care, I want to build relationships so these women will continue to come back for preventative and wellness services. I've found there are four primary reasons patients will schedule follow-up visits:

1. Family planning. Family planning is a big part of my practice. Teenagers and young women tend to be timid, and my priority is to be sensitive and find a personal connection. I smile, make eye contact, and sometimes hold their hand when I speak to them, so that I can gain their confidence. I explain birth control options and discuss STD prevention.

2. Depression and/or anxiety. During routine physicals, I frequently uncover symptoms of depression and anxiety. If patients are mildly depressed, I explain meditation techniques and may prescribe antidepressants and therapy. I have found that, often, even a short course of treatment can bring them back to feeling normal. For more serious issues, I refer to a psychiatrist or a psychologist. I also check to see if they may be in an abusive relationship, and if so, we look for community resources that can assist.

3. Weight loss. Female patients often ask about weight loss. The diet in this rural area seems to be high in fat and carbs. I provide basic nutrition counseling and explain carb and calorie counting. I also prescribe medication in the case of morbid obesity, but then I also refer to a nutritional or diabetes educator. Again, I stress prevention and educate patients about how they can take control of their weight and their health.

4. Menopause. For middle age and older women, I perform breast examinations and Pap smears and order mammograms. I ask about menopausal symptoms such as hot flashes and mood changes. I also educate them about natural alternatives to hormones, which have fewer or no side effects. At this point in their lives, they may have comorbidities that contribute to their symptoms. I help them understand menopause changes and manage any medications they are taking.

My goal is to treat patients the way I want to be treated — as if they were a family member. I'm fortunate to love what I do, and every day I thank my patients for the privilege of providing their care.