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Medical malpractice and risk management

Introduction A physician assistant‘s (PA’s) medical practice deals in a world of gray. There are few clinical situations a PA encounters that clearly and unequivocally present themselves so that a ready diagnosis and treatment plan can be implemented. The vast majority of patient encounters will result in the most common “gray” component of your practice: the differential diagnosis. Through a differential diagnosis, the PA sorts out…

Clinical ethics

Introduction Every clinical and public health decision has ethical components that are at times difficult to recognize and process. As John Glaser noted, there are “no ethics free zones.” , In the context of clinical care, ethical awareness is as essential as pathophysiology to bringing about a successful patient outcome. For the physician assistant (PA), the stage is set for complex ethical dilemmas, given their role…

Professionalism

Introduction Trust between the patient and clinician is central to the therapeutic relationship. Without this requisite level of trust, patients will not reveal information about themselves nor will they follow treatment recommendations. Trust builds from the belief that the clinician possesses expert knowledge (which will be applied to the benefit of individuals and society) and will avoid self-interest while acting on behalf of those served. Growing…

International clinical rotations

Introduction The purpose of this chapter is to provide physician assistant (PA) students interested in international clinical education with an overview of international clinical rotations (ICRs) to facilitate decision making about participation and to provide guidance on how to maximize the learning experience. This chapter emphasizes several guiding principles for student participation in ICRs: alignment of student goals with learning experiences; informed decision making toward participation;…

Other surgical subspecialties

Introduction Patients who require subspecialty surgical care may be referred to the surgeon by a primary care provider (PCP), a medical specialist, or another surgeon. Physician assistants (PAs) now work in nearly all surgical subspecialties. The need for PAs in the subspecialties continues to grow as resident work hours decrease, fewer surgical residency spots are available, and patient demand for these services increases. According to the…

Other medical subspecialties

Introduction This chapter aims to prepare students for clinical rotations in medical subspecialties, such as rheumatology, endocrinology, neurology, pulmonology, nephrology, infectious disease, and gastroenterology. Patient approach Typically, a patient is referred to one of these specialists by his or her primary care provider (PCP) for assistance with a condition that is out of the scope of the PCP’s practice or has been suboptimally managed in primary…

Oncology

Introduction to oncology Cancer remains a leading cause of death in the United States despite a steady decline in overall cancer mortality from 1999 to 2016. This downward trend in mortality is likely because of improvements in early detection and dramatic advances in our understanding of cancer pathobiology. These advances have fueled the unprecedented development of novel immunotherapies and targeted pharmacotherapeutic agents; however, traditional cytotoxic chemotherapeutic…

Orthopedics

Introduction Orthopedic medicine offers physician assistants (PAs) unique opportunities to practice team-based medicine at a high level. As a result of the opportunities in orthopedics, as well as the value PAs bring to the orthopedic care team, in 2018 more than 1 in 10 PAs in the United States practiced in orthopedic surgery. Musculoskeletal complaints are common in all medical settings; therefore a quality orthopedic experience…

Dermatology

Introduction Dermatology became a distinct medical subspecialty at the end of the 18th century; however, many dermatologic disorders were first described more than 2000 years ago. When confronted with a dermatologic complaint, you may recall the old adage, “If it’s wet, dry it, and if it’s dry, wet it.” This treatment approach has been ascribed to Hippocrates. During the third century BC, his Hippocratic Collection, also…

Cardiology

Cardiology and approach to the patient Cardiology is the internal medicine specialty of heart and vascular diseases and treatments. The primary goals of cardiology are to reduce morbidity and mortality and improve quality of life. This is accomplished by stabilizing patients with life-threatening emergencies, treating acute conditions, managing chronic diseases, and providing primary and secondary disease prevention. Methods of prevention and treatment include lifestyle modification, medication…

Emergency medicine

Patient approach Emergency medicine practitioners have one overarching goal for each patient: to answer the question, “Does my patient have a threat to life, limb, or sight today?” Emergency departments (EDs) are structured to provide life-saving services to patients in acute need. Determining which patients are in acute need, however, can be less than obvious. A woman with a classic presentation of gastroesophageal reflux may have…

Surgery

In cognitively demanding fields, there are no naturals. Nobody walks into an operating room straight out of a surgical rotation and does world-class neurosurgery. MALCOLM GLADWELL Patient approach Whenever a surgical provider approaches a patient, there are certain questions that should be considered, such as (1) “Will this patient benefit from surgery?”, (2) “Is surgery the most appropriate next step?”, and (3) “Is this patient a…

Behavioral science and medicine: Essentials in practice

Introduction Throughout history, many cultures have viewed mental illness as a form of religious punishment or demonic possession. In ancient Egypt, Greece, and Rome, mental illness was categorized as a religious or personal problem. During the Middle Ages, people believed mentally ill individuals were possessed or in need of religion. Negative attitudes toward mental illness persisted into the 18th and 19th centuries in the United States,…

Pediatrics

History Pediatrics gained recognition as a distinct medical discipline in the United States in the mid-19th century as an appreciation of the burden of infant mortality and awareness of the unique vulnerability of children to certain diseases increased. Before that, the medical concerns of children were viewed as the domain of internal medicine or obstetrics/gynecology, and there was little consideration given to the unique development and…

Women’s health

Introduction From the beginning of the physician assistant (PA) profession, primary care has been a key focus in training PA students. The special health care needs of women are an essential part of primary care. PA students will provide care for obstetric or gynecologic patients on a variety of clinical rotations, including obstetrics and gynecology (OB/GYN), family medicine, internal medicine, emergency medicine, and pediatrics. Most PA…

Internal medicine

Learning outcomes 1. Describe the practice of internal medicine. 2. Define the role of the physician assistant student on an internal medicine rotation. 3. Describe the challenges and rewards of practicing in internal medicine. Introduction Internal medicine is a medical specialty that provides comprehensive health care to adult patients. This includes health prevention and the management of complex acute and chronic diseases. The nature of the…

Family medicine

Introduction As a specialty in the United States, family medicine outnumbers all other medical specialties for both physicians and physician assistant (PAs). Physicians practicing in family medicine make up the largest percentage of the total physician workforce and, as shown in Fig. 20.1 , family medicine PAs account for the largest percentage of the total PA workforce. Family medicine emerged from a generalist model of medical…

Safety in clinical settings

Learning objectives After completing this chapter, the reader will be able to: 1. Review practical suggestions on maintaining personal safety when on clinical rotations. 2. Summarize the Centers for Disease Control and Prevention (CDC) recommendations on universal precautions associated with patient care. 3. Describe various personal and environmental safety risks that could impact the clinical phase student. 4. Distinguish various forms of student mistreatment and harassment…

Success in the clinical year

Introduction to the clinical phase Welcome to the clinical phase of your education! This year is the critical link between being a student and graduate physician assistant (PA). Through the guidance of your preceptors, faculty, and peers, you will have many opportunities to apply your newly acquired clinical knowledge and skills in the patient care environment. The transition into the clinical phase is often exciting but…