Physician Assistant: A Guide to Clinical Practice

PHYSICIAN ASSISTANT: A Guide to Clinical Practice......Page 2
Copyright......Page 3
Contributors......Page 4
Foreword......Page 10
Preface......Page 12
Acknowledgments......Page 13
OVERVIEW AND INTRODUCTION......Page 14
Feldshers in Russia......Page 17
Developments in the United States......Page 18
Concepts of Education and Practice......Page 19
Military Corpsmen......Page 20
Controversy about a Name......Page 21
Program Expansion......Page 22
Funding for Programs......Page 23
Accreditation......Page 24
Certification......Page 25
American Academy of Physician Assistants......Page 26
Association of Physician Assistant ­Programs to Physician Assistant ­Education Association......Page 29
Trends......Page 32
Current Issues and Controversies......Page 33
Clinical Applications......Page 34
3 - International Development of the Physician Assistant Profession......Page 37
Canada......Page 38
United Kingdom......Page 39
The Netherlands......Page 40
India......Page 41
South Africa......Page 42
Australia......Page 43
New Zealand......Page 45
Republic of Ireland......Page 46
Where Next......Page 47
Overview of Physician Assistant Education......Page 50
Physician Assistant Education Events......Page 51
Historical Context......Page 52
Physician Assistant Education Events......Page 53
Historical Context......Page 54
Characteristics of Physician Assistant Education......Page 55
Clinical Sites......Page 56
Diversity......Page 57
Doctoral Degree......Page 58
Cost of Education: Student Debt......Page 59
Leadership......Page 60
Conclusion......Page 61
Topics......Page 63
Rotation Safety......Page 65
Needlestick and Sharps Injuries......Page 66
Tuberculosis Screening......Page 67
Latex Allergy......Page 68
Sexual Harassment......Page 69
Patient Safety While on Rotations......Page 72
Introduction......Page 74
Accreditation Review Commission on Education of the Physician Assistant......Page 75
The Accreditation Process......Page 76
Types of Accreditation Site Visits......Page 77
National Certification......Page 79
History of the National Commission on Certification of Physician Assistants9......Page 80
Past and Future......Page 82
Licensure......Page 83
Clinical Applications......Page 84
7 - Physician Assistant Relationship to Physicians......Page 86
Dependent Practice Versus Interdependent Practice......Page 87
Delegated Scope of Practice......Page 88
Autonomous Medical Decision Making......Page 89
Physician Supervision: Legal Basis for Physician Assistant Practice......Page 90
Prospective......Page 91
Impact of Changing Health Care Systems......Page 92
Practice Ownership......Page 93
Summary......Page 94
8 - Health Care Financing and Reimbursement......Page 97
Medicare......Page 98
Medicare Part B......Page 99
“Incident to” Services......Page 100
Certified Rural Health Clinics......Page 101
Private Insurance......Page 102
Accountable Care Organizations......Page 103
Pay for Performance and Pay for Reporting......Page 104
A Unique Concern for Physician Assistants......Page 105
Clinical Applications......Page 106
Individual Responsibilities......Page 109
Practice Laws......Page 110
Federal Legislative Process: How a Bill Becomes Law......Page 114
State Legislative Process......Page 115
State Regulatory Process......Page 118
Case Studies......Page 122
Conclusion......Page 123
Background and Rationale for Interprofessional Practice and Interprofessional Education......Page 126
Barriers to Interprofessional Education......Page 129
Interprofessional Education Competencies......Page 130
Requirements for a Good Team Leader or Facilitator......Page 131
Conflict Management......Page 132
Summary......Page 133
History of Evidence-Based Medicine......Page 136
Task 2: Searching for Evidence......Page 137
Research Study Design. After the primary literature has been searched and sources of evidence identified, it is important to ass.........Page 138
Evidence: Translating the Greek......Page 140
Task 3: Evaluating the Evidence......Page 141
Potential Threats to Validity. Potential threats to both external and internal validity must be considered when evaluating these.........Page 142
Commonly Used Outcome Measures. In a study evaluating a new screening or diagnostic test the commonly used measures include sens.........Page 143
Commonly Used Outcome Measures. Prognosis studies may employ a number of outcome measures, including measures of mortality as we.........Page 145
Potential Threats to Validity. There are a number of important characteristics of RCTs that need to be evaluated when assessing .........Page 146
Commonly Used Outcome Measures. The outcome measures in a review article are usually reflective of those in the individual artic.........Page 147
Potential Threats to Validity. Publication bias in a systematic review article or meta-analysis affects the validity of the stud.........Page 148
Task 5: Evaluating the Process......Page 149
Basic Science Biomedical Research......Page 151
Clinical Research......Page 152
Workforce Research......Page 155
Why Should Physician Assistants be Involved in Research......Page 157
Physician Assistant Students and Research......Page 158
Conclusion......Page 159
13 - Keeping People Healthy......Page 162
Primary, Secondary, and Tertiary Prevention......Page 163
Immunization Strategies......Page 165
United States Preventive Services Task Force......Page 167
Influencing Health Behavior Changes......Page 168
Conclusion......Page 170
14 - Clinical Procedures......Page 172
Wound Healing......Page 173
Maturation Phase......Page 174
Wound Anesthesia......Page 175
Sutures......Page 176
Choice of Suture......Page 177
Delayed Primary Closure......Page 178
Healing by Secondary Intention......Page 179
First Principle......Page 180
Wound Tension......Page 181
Poor Technique......Page 182
Poor Skin Quality......Page 183
Skin Glue......Page 185
Universal Precautions......Page 186
Equipment. The following equipment should be assembled......Page 187
Intradermal Injections......Page 188
Phlebotomy......Page 189
Patient Preparation. The procedure should be explained to the patient to help reduce anxiety and elicit cooperation. The patient.........Page 190
Catheter Selection. Considerations in selecting the correct catheter include the size and condition of the vein and the viscosit.........Page 191
Contraindications. Poor collateral circulation in the hand, as determined by the Allen test, or no palpable pulse in the radial .........Page 192
Equipment. A prepackaged blood gas sampling kit may be used, or assemble the following......Page 193
Lumbar Puncture......Page 194
Patient Preparation......Page 195
Follow-up......Page 196
Equipment......Page 197
Equipment......Page 198
Follow-up......Page 199
From the Genetic Age into the Genomic Age......Page 201
Genetics and Genomics: The Language of Modern Medicine......Page 202
The Diagnostic Utility of Family History Data......Page 203
Collecting Family History Data and ­Creating a Pedigree......Page 204
Pedigree Analysis......Page 205
Genetic and Genomic Testing......Page 206
Definition of a Genetic or Genomic Test......Page 207
Carrier Screening May Reveal Asymptomatic and Symptomatic Individuals......Page 208
Prenatal Genetic Testing......Page 209
Clinical Decision-Making Framework for Genetic Testing......Page 210
The Physician Assistant’s Role in the Genomic Age: Putting it all Together......Page 211
A Need for Coordinated, ­Patient-Centered Care......Page 217
Elements of the Chronic Care Model......Page 218
Self-Management and Self-Management Support......Page 220
Motivational Interviewing and Action Planning......Page 221
Population-Based Chronic Disease Management......Page 224
Use of Technology in Chronic ­Disease Management: New Frontiers......Page 228
Clinical Applications......Page 230
History of Prescription Writing......Page 235
Content of a Prescription2......Page 236
Evidence-Based Approach to Medical Decision Making......Page 237
Pharmacokinetics......Page 238
Geriatrics......Page 240
Pregnancy and Lactation......Page 241
Barriers to Patient Compliance......Page 242
Ethical Quandaries......Page 243
Conclusion......Page 244
18 - Complementary and Integrative Health......Page 246
Natural Products......Page 248
Mind–Body Practices......Page 250
Addressing Complementary and Integrative Health in Clinical Practice......Page 251
Clinical Applications......Page 252
19 - Geriatric Medicine......Page 254
Functional Status......Page 255
Cardiovascular Changes......Page 257
Endocrine Changes......Page 258
Dementia......Page 259
Dementia Workup......Page 260
Delirium......Page 261
Functional Incontinence......Page 262
Instability and Falls......Page 263
Screening and Health Promotion......Page 264
Dizziness and Syncope......Page 266
Depression......Page 267
Sexuality and Aging......Page 269
Elder Abuse......Page 270
Ethnogeriatrics......Page 271
End of Life......Page 272
Multipurpose Senior Centers......Page 273
In-Home Care......Page 274
Clinical Applications......Page 275
Truth Telling......Page 280
Planning for Death......Page 281
Advance Directives......Page 282
Out-of-Hospital Do Not Resuscitate Orders......Page 283
Having the Conversation......Page 284
Stages of Grief......Page 286
Clinical Applications......Page 287
Glossary......Page 288
Patient-Centered Communication......Page 291
Barriers of Communication......Page 292
Interprofessional Communication......Page 293
Health Information Technology......Page 294
Conclusion......Page 295
References......Page 296
Development......Page 299
Implementation......Page 300
Safety......Page 302
Clinical Applications......Page 303
Barriers to Patient Education......Page 306
Patient Barriers......Page 307
Health Literacy9,10......Page 309
Providing Structure for Effective Patient Education......Page 310
Introduction to Culturally Competent Practice......Page 316
Rationale......Page 317
Cognitive Errors in Decision Making......Page 318
Language Barriers......Page 319
Special Populations......Page 320
Conclusion......Page 321
History Repeats Itself......Page 325
The Specialty of Family Medicine......Page 326
The Family Medicine Clinical Rotation......Page 328
Common Medical Procedures in Family Medicine Practices......Page 329
The Benefits of Practicing Family Medicine......Page 331
Conclusion......Page 332
Physician Assistants in Internal Medicine......Page 335
Clinical Environment......Page 336
Challenges And Rewards......Page 337
Surgery Service......Page 339
Outpatient Service......Page 340
Expectations for a Successful Rotation......Page 341
Interprofessionalism on Obstetrics and Gynecology......Page 342
Promotion of Wellness......Page 343
Student and Faculty Resources......Page 345
Student Tips......Page 346
Special Challenges......Page 347
Conclusion......Page 348
History......Page 350
Well Child VISITS AND IMMUNIZATIONS......Page 351
Ambulatory Pediatrics......Page 353
Newborns......Page 355
Behavioral and Mental Health Disorders......Page 356
Chronic Disease......Page 357
29 - Behavioral Science and Medicine: Essentials in Practice......Page 358
Identifying Information......Page 359
Psychiatric Review of Systems......Page 360
Plan and Treatment......Page 361
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition......Page 363
Expectations of Physician Assistant Students on Psychiatric Clinical Rotations......Page 364
Motivational Interviewing......Page 365
The Role and Future Physician Assistants in Psychiatry......Page 366
Clinical Applications......Page 367
30 - Surgery......Page 369
Hospital Operations......Page 370
Hospital Operations......Page 372
Which Clinical Environments may I Work in During the Surgery Rotation......Page 374
Anesthesiologist......Page 375
Scrub Nurse or Registered Nurse First Assist......Page 376
What are the Special Rewards of Surgery......Page 377
Self-Gowning and -Gloving......Page 378
How do Practitioners in Emergency Medicine Approach the Patient......Page 382
What will I be Expected to do on this Rotation......Page 383
Which Special Populations of Patients may I see on this Rotation......Page 384
What Resources Might be Helpful to me on this Rotation......Page 385
Physician Assistants in Cardiology......Page 386
What to Expect and Know......Page 387
Patients and Special Populations......Page 388
Summary......Page 390
Approach to the Patient......Page 391
Typical Day......Page 392
Clinical Settings......Page 395
Essential Clinical Information to be Obtained from Each Patient......Page 396
What are the Special Challenges of Dermatology......Page 397
Physician Assistants’ Daily Tasks in Orthopedics......Page 400
Team Learning from Health Professionals on the Orthopedic Team......Page 401
What are the Special Challenges of Orthopedics......Page 406
What are the Special Rewards of Orthopedics......Page 409
For the Student......Page 414
Demographics......Page 416
Cancer Prevention......Page 417
Patient Care......Page 418
Cancer Care......Page 419
Cancer Care in the Twenty-First Century......Page 420
Goals of Treatment......Page 421
Clinical Applications......Page 422
How do Practitioners in Medical Subspecialties Approach the Patient......Page 425
What will I be Expected to do in this Rotation......Page 426
Neurology......Page 427
Rheumatology......Page 428
Infectious Diseases......Page 429
Endocrinology......Page 430
Pulmonology......Page 431
Nephrology......Page 432
Gastroenterology......Page 433
Gastroenterology......Page 434
What Resources Might be Helpful to me on this Rotation......Page 435
How do Practitioners in Surgical Subspecialties Approach the Patient......Page 436
What Will I be Expected to do on this Rotation......Page 437
Cardiovascular and Thoracic Surgery......Page 438
Neurosurgery......Page 439
Urologic Surgery......Page 440
Trauma Surgery......Page 441
Burn Surgery......Page 442
What Resources Might be Helpful to me on these Rotations......Page 443
33 - Professionalism......Page 445
Elements of the Physician Assistant Competency of Professionalism......Page 446
Values: Respect, Compassion, and Integrity......Page 447
Sensitivity and Responsiveness to a Diverse Population......Page 448
Accountability to Patients, Society, and the Profession......Page 449
Know Professional and Personal Limitations......Page 450
Conclusion......Page 451
Clinical Applications......Page 452
Chapter Organization......Page 456
Methodology......Page 457
“God Squad”: An Early Ethics Committee......Page 458
Tuskegee Study......Page 459
Quinlan Case......Page 460
Cases......Page 461
Ethics Consultation and Resources......Page 473
What is Medical Negligence......Page 476
Causation......Page 477
Informed Consent......Page 478
Initial Filings......Page 479
Trial......Page 480
Risk Management Techniques......Page 484
Clinical Applications......Page 485
History of Postgraduate Residency Education......Page 487
Currently Available Programs......Page 488
Application Process......Page 489
Credential Awarded......Page 490
Residency Program Accreditation......Page 491
Residency Graduate Employment Opportunities......Page 492
Selecting a Residency Program......Page 493
Conclusion......Page 498
Clinical Applications......Page 499
Experience of Stress in Training......Page 501
Educating Patients and Their Families......Page 503
Patient Care Issues......Page 504
Formal Professional Issues......Page 505
Assessment and Treatment......Page 506
Conclusion......Page 508
Clinical Applications......Page 509
What are Health Disparities......Page 511
Sexual Orientation......Page 513
Geographic Location......Page 514
Clinical Applications......Page 515
Quality Care Movement in America......Page 518
Why Errors Occur......Page 519
Diagnosis Errors......Page 520
Medication Errors (Fig. 39.2)......Page 521
Surgical Errors (Fig. 39.3)......Page 522
Recommendation......Page 524
Patient Safety Strategies......Page 525
Role of the Patient......Page 526
Clinical Applications......Page 527
Health Systems......Page 533
Describing National Health Systems: United Kingdom, Canada, and the United States......Page 534
How Is Care Financed......Page 535
Horizontally Integrated Systems......Page 536
Cost......Page 538
Population Health......Page 540
Patient-Centered Medical Homes......Page 541
Accountable Care Communities......Page 544
“The Terminology of Health Reform”......Page 547
41 - Rehabilitative and Long-Term Care Systems......Page 548
Home Care: Informal Caregivers......Page 549
Home Care: Home Care Organizations......Page 550
Hospice......Page 551
Medical House Calls......Page 552
Nursing Homes......Page 553
Adults......Page 556
Health History......Page 557
43 - Correctional Medicine......Page 561
Access to Care......Page 562
Clinical Autonomy......Page 563
Staffing Issues......Page 564
Staff and Inmate Safety......Page 565
Community-Acquired Methicillin-Resistant Staphylococcus aureus......Page 566
Tuberculosis......Page 567
Sexually Transmitted Diseases......Page 568
Asthma......Page 569
Diabetes......Page 570
Suicide......Page 571
Pain Management......Page 572
Autonomy......Page 573
Confidentiality......Page 574
Conclusion......Page 575
Clinical Applications......Page 576
Author Disclosure Statement......Page 577
History of Military Physician Assistants......Page 580
The Interservice Physician Assistant Program......Page 581
Recruiting Challenges......Page 582
Role of Physician Assistants in the Military Health System......Page 583
Wartime......Page 584
Service Impact......Page 585
Conclusion......Page 586
Disclaimer......Page 587
45 - Inner-City Health Care......Page 589
The Growth of the Urban Environment and the Inner City......Page 590
Diversity in the Inner City......Page 592
Health Care in the Inner City......Page 594
Effects of Social Isolation in the Inner City......Page 596
Role of Public Health Departments......Page 597
Homeless Health Care in the Inner City......Page 598
What is Rural, and Why Does it Matter......Page 602
Definitions of Rural......Page 603
Aging Populations......Page 604
Access to Health Care......Page 605
Rural Health Care Systems: Hospitals, Clinics, and the Safety Net......Page 606
Early Models......Page 607
Criteria for Critical Access Hospital Certification......Page 608
Community and Migrant Health Centers......Page 609
Rural Health Clinics......Page 610
Funding and Reimbursement for Rural Health Services......Page 611
Rural Health Workforce Issues......Page 612
Physician Assistants and Rural Medicine......Page 613
Federal and State Policy Implications for Rural Health Care......Page 614
Requisites for Rural Physician Assistants......Page 615
Challenges and Rewards of Rural Practice......Page 616
47 - International Health Care......Page 620
General Issues......Page 621
Malpractice......Page 622
Public Health and Epidemiology......Page 623
Traditional Health Care......Page 624
Topics for Preparation......Page 625
Clinical Applications......Page 628
48 - Patients with Disabilities......Page 631
Terms and Definitions......Page 632
Best Practices......Page 633
Methods to Ensure Access......Page 634
Terms and Definitions......Page 635
Best Practices......Page 636
Methods to Ensure Access......Page 637
Best Practices......Page 638
Providing Appropriate Care for Patients with Intellectual and Developmental Disabilities......Page 639
Best Practices......Page 640
Clinical Applications......Page 641
49 - Mass Casualty Natural Disaster......Page 645
Principles of Triage......Page 646
Chemical Disasters......Page 647
Biological Disasters......Page 648
Radiologic Dispersal Devices (Dirty Bombs)......Page 649
Tornadoes......Page 650
Preparing Before Disaster Strikes......Page 651
Posttraumatic Stress Disorder......Page 654
Special Populations......Page 655
Personal Stories......Page 658
Henry Curran, PA-C......Page 660
Physician Assistants in Leadership......Page 663
Benefits from Leadership Roles......Page 664
Conclusion......Page 665
51 - Be a Physician Assistant Educator......Page 667
Academic Director......Page 668
Clinical Director......Page 669
Director of Admissions......Page 670
Program Director......Page 671
What is Professional Service......Page 675
Why Should I Get Involved in ­Professional Service......Page 678
How Can I Get Involved in ­Professional Service......Page 679
53 - The Future of the Physician Assistant Profession......Page 681
What are the Characteristics of Learning Objectives......Page 683
Common Errors and Pitfalls......Page 684
Answers......Page 685
Writing the Vignette......Page 686
Writing the Lead-in Question......Page 687
Avoiding Testwise Clues......Page 688
Example 1......Page 689
Example 7......Page 690
Team-Based Learning Defined......Page 692
Why Team-Based Learning Clues that Lectures may not be Working......Page 693
Overview of the Team-Based Learning Process......Page 694
Selecting Readings for Pre–Team-Based Learning Preparation (Individual Study)......Page 695
Phase II: The Readiness Assurance Process......Page 696
The Role of the Instructor(s) in Team-Based Learning......Page 697
Foundational Team-Based Learning Readings......Page 698
Summary......Page 699
APPENDIX......Page 700