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Staff Spotlight: Autumn Konz, PA-C

Wednesday, June 20, 2018
Autumn Konz

Before coming to Duke, Autumn Konz, PA-C, saw patients in a small, rural clinic in northern California, sometimes with only a machine that dispensed blood pressure medications as her only other colleague. Now as an advanced practice provider (APP) in Duke Neurology in Raleigh, she sees patients with neurological conditions in a much larger setting. In this week’s “Spotlight” interview, Konz talks about the contrast between these locations, the problem-solving approach she takes to diagnosing and treating patients, and learning to grow lilies, cook, and salsa dance when not at work.

What are your responsibilities as part of the Neurology Department and Duke Health?
I am a physician assistant who evaluates and treats a variety of neurologic concerns in the outpatient setting at Duke Neurology of Raleigh.

What does your average work day look like?
Generally I am at the office around 7 a.m. and spend an hour answering patient questions, completing paperwork, and reviewing cases for the day. On average nine or 10 general neurology patients are scheduled. Most days clinic ends around 4 or 4:30 pm. For two to three hours after clinic, I am charting, addressing patient advice requests, reviewing labs, neuroimaging, or consulting with supervising providers. I have no call responsibilities which is definitely a perk.

How did you decide to become a physician assistant? How did you decide to focus on neurology in particular?
I took a rather circuitous route to become an APP provider in neurology. I was interested in neuroscience and chemistry in my adolescence. In undergrad I pursued a degree in biochemistry, but wanted exposure to neuroscience. For this reason I spent one year working with Dr. John Doughery as a research coordinator for Cole Neuroscience at University of Tennessee Medical Center. I authored small grants, recruited research subjects, worked with the IRB, and performed basic cognitive testing. Following this I used my formal training in chemistry at Moffit Cancer Research Center for a couple of years. Though Linux proved to be a wonderfully malleable OS, and I appreciated the sophistication of Glide and Schrödinger software, I missed neurology.

During this time I was working in both organic synthesis and computation chemistry. Though interesting, I missed working in neurology, and returned to UT Medical Center where the neurologist I had worked with in the previous years encouraged me to consider clinical practice. A few years into practice as a PA Duke opened a one-year APP Neurology Residency and I was fortunate enough to be able to take advantage of the training opportunity.

Where else have you practiced as a physician assistant? How does Duke Raleigh compare to those locations?
Prior to Duke, I practiced general medicine in a rural underserved area in northern California. It was a relatively remote clinic and many times there were only one or two providers on site. There were some significant differences in patient population and available resources. We had a machine that dispensed blood pressure medications because the nearest pharmacy was 30-45 minutes away, and many of our patients did not have reliable transportation nor money to pay for medications. We had a helicopter pad to lift people that needed urgent/emergency care as the hospitals that treated heart attacks or stroke were over an hour away. Working here has definitely been a change of pace, but I am enjoying the contrast.

What do you enjoy most about your work?
This is a difficult question as there are so many aspects of work that I enjoy. Neurology is like a puzzle, and I am continually learning more about the pieces and how they fit together. The myriad of presentations that neurologic disease may present with fascinates me. It is a privilege to be able work with the neurologists I work with and am grateful for their willingness to teach.

What’s the hardest part of your job?
There are two things that are as equally hard for me a) explaining to a patient that what ails them is not neurologic in origin or b) explaining that there is very little or nothing more we can do for them. An example of the first may include patients who experience symptoms without any objective findings. This may be the result of our incomplete understanding of human pathophysiology and technological limitations or an undiagnosed or pre-existing undertreated psychiatric condition. Alternatively, they may have been referred for incidental abnormalities found on neuroimaging and symptoms inappropriately associated with the findings. It may seem obvious that for every test ordered there are results, but the impact of those results can be more distressing than the symptom that prompted the CT or MRI of brain or spinal cord.

Examples of situations where there is very little I have to offer is not necessarily diagnosis driven, but more case by case. An example may be neuropathy which has a plethora of causes, and about 50% of the time we do not have a definitive answer as to why someone has developed it. Can you imagine slowly losing the feeling in your feet or hands, becoming unstable on your feet, and no one being able to tell you why it is happening? Then to add insult to injury, you have intractable pain despite being on multiple medications with side effects? Every day patients remind me of our capacity for unwavering fortitude.

What passions or hobbies do you have outside of the Department?
I enjoy almost anything that is outside. I can easily pass time cycling, reading, swimming or backpacking. Lately, I have been attempting to grow lilies, learn to salsa, and cook without a grill, but to date I am only successful at one of the three.

Konz poses with her brother during a recent trip to the beach.