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Who is a Physician Assistant?
Prof P Krishnam
Raju
Chairman Care Foundation & Consultant
Cardiologist
A Physician Assistant (PA) is a health professional trained in the
medical model who would work with physician supervision to extend
patient access to care.
The scope of the PAs practice corresponds to the supervising physician's
practice. The physician assistant is a representative of the physician,
treating the patient in the style and manner developed and directed by
the supervising physician. Physician assistants are taught to "know our
limits" and refer to physicians appropriately. As things stand today,
PAs can assist a patient in a variety of manner except that they can’t
write a prescription.
It is important that proper identity of Physician Assistants is defined
within the matrix of healthcare industry by appropriately placing them
in the hospital job-structure. The various roles and skills are
enumerated below where there is an obvious void creating problems
related to both healthcare quality and patient satisfaction.
Roles towards patients:
Managerial skills
1. PA can assist patients to have prompt and easy access to a specialist
of his or her choice and having that specialist accept the patient and
see him or her in OP without a lengthy delay.
2. PA can be a liaison between the patient and other consultants to whom
your physician has referred the patient. PA can facilitate that patient
is seen by other consultants promptly and having them send comprehensive
reports to your physician in a timely manner. Often a phone call by the
consultant to physician is essential.
3. PA can assist patient to gain timely access to his/her physician for
urgent or emergency care after hours and on weekends.
Emotional skills
4. PA can assist patients to allay their fears while they are undergoing
diagnostic testing or therapeutic procedures that carry real risk or
appear formidable.
5. PA can welcome personally, or get the patient met at the front door
of the hospital or in the main lobby by a cheerful and caring greeter.
Assistance in parking care is very much valued by visiting patients.
Front Office is most sensitive area of a hospital. Hospitals are not
hotels, railway stations and bookshops. There is a lot of sensitivity
involved here. Ninety percent patients accept a wheel chair and transfer
to Emergency Room if nothing else is possible.
Knowledge skills
6. PA can be a caring and empathetic person who takes the time to
explain to the patient what was found in the medical evaluation,
describe the disease process in lay terms without hurry and show
sensitivity and compassion when having to relate bad news. PA can also
display a realistic but positive attitude about treatment plans, and
fully explains why certain tests are being ordered and specific drugs or
procedures are being recommended.
There is no need for telling lies or soothsaying. Facts need to be
neatly told. American College of Cardiology (ACC) has published
excellent booklets. These can be learned by heart by PAs and explained
to the patient the scientific rationale of the treatment prescribed to
him/her or tests/procedures ordered. Legal position demands that patient
is a part of decision making about the treatment. PA can help best in
helping patient/family to a take a good decision.
Roles towards Physicians:
Managerial skills
7. PA can assist his/her physician in promptly returning patient’s phone
calls. Give patient timely reports of laboratory tests, and be more than
willing in getting him or her consult other specialists when needed.
Emotional skills
8. PA can assist his/her physician in talking down to patient and
include patient in the decision making process with respect to
determining the best course of medical care. A feeling of being mentally
solid must be inculcated. In helping the patient, the job of PA is to
help a patient not to cry with him/her. Death should never destabilize a
hospital hand. Create defence walls around is an essential part of
learning in a hospital.
Knowledge skills
9. PA can assist his/her physician in being current with medical
knowledge and accepted guidelines with the disease process of the
particular patient. Cardiology that I learnt in 1970s and what we
practice now are quite different. PA can assist a physician to travel
with the medical knowledge. It also works in reverse. New doctors learn
most from old nurse.
10. PA can assist his/her physician by spending appropriate amount of
time with the patient to take required history and physical examination
and relate the subsequent recommended plan for further diagnostic
testing and/or treatment. This would entail physician being good
listener and not interrupting patient’s description of symptoms because
he or she is in a hurry. Detection of disease is very similar to
crime-detection. It demands all-embracing attention. A good history
taking and physical examination can avoid excessive investigation
procedures saving money for the patient and lessening burden on economy.
There are instances when patient is left with no money after diagnosis
to buy medicines.
Roles in the hospital:
Managerial skills
11. PA can manage the waiting time after registration including
overseeing that diagnostic tests ordered are smoothly carried out with
waiting at multiple locations.
12. PA can help meeting the needs of the patient family members and
providing support services to them, if needed.
13. PA can connect patient to professional counselling services and
patient support groups. PA can also provide patient with educational
materials written in lay language about specific disease entities.
14. PA can assist patients in streamlining his or her insurance plan
approvals with diagnostic and therapeutic procedures as well as drugs
that, despite being costly, are the most appropriate for the disease
being treated and insurance company consenting to pay for the necessary
medical care. These days one day in hospital can easily cost Rs. 15,000
- 20,000. Most of the farmer suicides reported in districts is on
account of unserviced healthcare debts when a crop fails.
15. PA can help patients understand hospital bills. PA can guide a
patient well about how much the treatment is really going to cost at
various intermediate stages and overall. There is lot of
misunderstanding prevalent on this account.
16. PA can assist patients in not having to wait long periods of time in
a pharmacy to pick up prescriptions ready when patient arrive to pick
them.
Emotional skills
17. PA can assist in maintaining confidentiality of the medical
condition of the patient from the general hospital staff and safeguard
the privacy of the patient. Don’t ever imagine that all people seeking
information about a patient’s health are his/her well-wishers.
In Indian hospitals it is very common to take photocopies of case
sheets. Also patients are discussed in public areas like lifts and
canteen. It is not only wrong but also indecent. IN USA there is a law (HIPPA)
to safeguard patient information. PAs can be both warden and guard of
patient information.
Knowledge skills
18. PA can provide certain house services like collection of laboratory
samples, physiotherapy, respiratory therapy, nursing services, and so
on. Lot of routine things that are done in the hospitals can be safely
done at homes. Suture removal, dressing, injections and tubes/ urine
catheterisation are some examples. Follow-up visits and drug adjustments
are two very important areas where PAs can pitch in.
The average age in India is currently 65 years and is increasing. Soon,
25% population will be 65 years and old. Home health services in cases
of heart disability, stroke-survivors, fractures, kidney problems and
cancers will have huge demand. PAs will be best suited to position
themselves in this niche market.
Transplant of cadaver organs is arriving on scene. There are 500,000 new
patients needing kidney transplant in India alone whereas not more than
1000 kidney are available. Burning and burying organs that can give a
new lease of life to someone other is indeed a tragedy but there is
strong taboo against cadaver organ donation. Pas can be the important
members of the transplant teams.
It is evident from the Table above that a Physician Assistant mainly
bridges the administrative gap between the physician and the hospital
services that creates avoidable hardship for the patient. Physician
assistants are more useful in providing emotional comforts to the
patients and knowledge assistance to the physician.
The list is not necessarily a compilation of all the factors that
contribute to patient satisfaction and quality medical care. The focus
is on patient satisfaction. No matter how sophisticated and reputed a
medical facility may be, and no matter how brilliant and knowledgeable
the physicians practising there, patients will not perceive their care
as being excellent unless they are satisfied with respect to many gaps
that I attempted to enumerate here. With physicians high pressed for
time, there is a real requirement of physician’s assistants who are
truly concerned about their patients and communicate with them
effectively, for whom the patient comes first, for whom the welfare of
patients remain their highest priority.
What does NSOU-Care Foundation PA course offer?
The first year of PA education at NSOU-Care Foundation would provide a
broad grounding in medical principles with a focus on their clinical
applicability. This instructive curriculum typically consists of
coursework in the basic sciences, including anatomy, physiology,
biochemistry, microbiology, clinical laboratory sciences, physical
diagnosis, and behavioral sciences. The student would receive hands-on
clinical training through a series of rotations in a variety of
inpatient and outpatient settings. The student would do internship in
the Laboratory Medicine Department.
In the second year, students will be taught essential Pathophysiology,
practice of Internal Medicine, Diagnostics methods and apprised of
medical ethics. The training will include hands on experience in family
medicine, obstetrics and gynecology, pediatrics and psychiatry. The
student will be initiated into clinical research and will be taught
pharmacology and essential medical statistics. The student would do
internship in the Pharmacy. Rotations in a variety of inpatient and
outpatient settings would continue.
In the third year, students will be taught essential Nursing, Emergency
Medicine and Surgical Methods. The clinical research will be extended to
epidemiology and epistemology and students will be taught Medical
Informatics. The student would do internship in the Medical record
Department. Rotations in a variety of inpatient and outpatient settings
would continue.
Conclusion
In Indian hospital settings, arrival of Physician Assistants is a rather
topical phenomenon. The role conflict particularly with Nurse
Practitioners and Medical Assistants is therefore expected. It is
important at this point of time differentiate. The guideline is:
(1) Physician Assistants and Nurse Practitioners both provide similar
services, the major distinction being that nurse practitioners are
registered nurses by trade.
(2) PAs should not be confused with Medical Assistants, who perform
routine clinical and clerical tasks in a physician's office.
Going by the trend of healthcare industry acquiring the tone and theme
of a specialized service industry, PAs are going to be crucial Human
Recourse. There are also immense entrepreneurial possibilities for PAs
to start their own services subsidiary to the hospitals.
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