From EMS
to Continuity of Care

By:   January 19, 2016

Nicole Jakeman – Tacoma Class 2

Prior to entering the MEDEX physician assistant training program as a member of Tacoma Class 2, Nicole Jakeman worked in two areas of healthcare that appear to be polar opposites — emergency medicine and massage therapy.

“They are,” she agrees. “And that’s the reason I chose them, for that balance.” Nicole studied to become a Licensed Massage Therapist while working in EMS, where she spent about eight year.

Currently in her clinical year with MEDEX, we caught up with Nicole during her 4-month family medicine preceptorship with Dr. Peter LoGerfo in Puyallup, WA. This is a long way from her role as a paramedic, where she’d jump into an emergency medical situation and triage, addressing the most immediate needs, then passing the patient off to a hospital facility.

“It’s been a really good experience being able to see patients return, and find out how they’re doing,” she says. “We’re able to tweak their care if something’s not quite right. We can make adjustments.”

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In this small clinic setting Nicole is able to observe the stages patients go through, and see the outcomes of treatment. “It’s been a very satisfying experience. With EMS you don’t learn a lot about the final diagnosis with your patient. Just drop them off, and you’re onto the next one. But being here and helping people through some difficult times— or some exciting times, like delivery—we then see them come back, and watch the infants grow.”

Already, she’s attended at some deliveries, and seen those mothers bring in their two-month-old children for checkups. “I get to see how the family is developing and adjusting,” she says. “It’s very exciting.”

Peter LoGerfo, MD operates a successful family practice in the South Sound region, with an emphasis on obstetrics and newborns. He has many loyal patients that have been with him during his whole practice, almost 20 years now. Some patients travel as much as a couple hours to come and see Dr. LoGerfo. “It’s because he’s been such a great provider for them,” says Nicole. Her time at this small clinic allows her to observe a continuity of care, and what it means to develop trust and relationship with patients.

Nicole volunteers as a massage therapist at a military spouse appreciation convention.

Nicole volunteered her massage services at a military spouse appreciation convention.

And then there’s the teaching which, after all, is why she’s there. “Dr. LoGerfo takes the extra time to meet with me before clinic hours to review things where I need a little practice, like understanding lab values and how that affects outcome of the treatments,” she says. “He works with me on medications, making sure I understand finer details of prescribing. It’s been an excellent learning environment.”

The earlier move from paramedic to a massage practice was a conscious decision to step back from the adrenaline mode that comes with EMS. The massage background gave Nicole some additional tools in addition to allopathic medicine. “I’m bringing a lot of my massage therapy ways into practice here,” she tells us. Dr. LoGerfo’s gives her the opportunity to refer patients to massage therapy or acupuncture. “He’s allowing me to consider other natural types of interventions. I think the patients are very open to that. A lot of patients are wanting a holistic approach to their care, and it’s been exciting to be able to blend them.”


Nicole grew up in Tacoma, so attending the MEDEX Tacoma site was an easy choice. She came to the decision after an earlier experience with a PA. “My grandmother was sick with dementia, and it was a PA that helped get us find the right kind of care for her, and that transition to end-of-life care,” she says. That physician assistant was very significant to Nicole and her family. “I saw the time she took to make sure that the diagnosis for my grandmother was correct, and that really impressed me. That was something that I wanted to be able to do as well, so going to MEDEX was really a dream come true.”

Nicole informed her parents that she was accepted into MEDEX by dressing up in Husky purple.

Nicole informed her parents that she was accepted into MEDEX by dressing up with her children in Husky purple.

Nicole is a single mom with two children who were two and three at the time she entered the rigors of the MEDEX didactic year. “That first year in the program was a lot of balancing,” she says. Her family was very supportive and got her through it. Then there was the support of her classmates. “I had a great situation in that I was neighbors with three of my classmates, and so we had a built-in study group. We pulled together and got each other through. It was great.”

She’s done a little PA proselytizing on her own during this current family practice preceptorship. A few of the patients she’s seen have been volunteer firefighters, something Nicole did in her EMS days. “They’ve talked to me about transitioning to become a physician assistant, applying to MEDEX and what that’s like. And I’ve told them it’s excellent. It’s a great opportunity. This field is wide open and there are lots of choices. Here, I’m seeing how I can be a part of the provider team.”

“I’m right where I’m supposed to be,” she concludes.

Dennis Raymond is the Communications Manager for MEDEX Northwest in Seattle, Washington. He can be reached at