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Physician Assistant: A Guide to Clinical Practice E-Book

Physician Assistant: A Guide to Clinical Practice E-Book

Ruth Ballweg | Darwin Brown | Daniel Vetrosky

(2012)

Additional Information

Abstract

Prepare for every stage of your physician assistant career with Physician Assistant: A Guide to Clinical Practice, 5th Edition - the one text that takes you from your PA coursework through clinical practice! Concise, easy to read, and highly visual, this all-in-one resource by Ruth Ballweg, Edward M. Sullivan, Darwin Brown, and Daniel Vetrosky delivers the current, practical guidance you need to know to succeed in any setting.

  • Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located.
  • Master all the core competencies you need to know for certification or recertification.
  • Navigate today's professional challenges with new chapters on NCCPA Specialty Recognition; Communication Issues; the Electronic Health Record; Patient Safety and Quality of Care; Population-Based Practice; and Physician Assistants and Supervision.
  • Meet ARC-PA accreditation requirements with coverage of key topics such as Student Safety in Clinical Settings, Health Care Delivery Systems, Population-Based Practice, and Mass Casualties/Disasters.
  • Keep up with the PA competencies that are endorsed by the AAPA, PAEA, NCCPA, and ARC-PA.
  • Master key concepts and clinical applications thanks to a succinct, bulleted writing style; convenient tables; practical case studies; and clinical application questions throughout.
  • Retain what you’ve learned and easily visualize every aspect of clinical practice with a new full-color design and illustrations throughout.
  • Explore global options with expanded coverage of physician assistants in international medicine.

Table of Contents

Section Title Page Action Price
Front Cover Cover
IFC IFC
Physician Assistant: A Guide to Clinical Practice iii
Copyright iv
Contributors v
Foreword xi
Preface xiii
Acknowledgments xv
Section I - Overview 1
Chapter 1 - History of the Profession and Current Trends 3
China’s Barefoot Doctors 4
Developments in the United States 4
Developments at Duke University 5
Concepts of Education and Practice 5
Military Corpsmen 6
Other Models 7
Controversy about a Name 7
Program Expansion 8
Accreditation 10
Certification 11
Organizations 13
Trends 19
National Health Policy Reports 19
“Futures” Events 20
Current Issues and Controversies 21
Conclusion 26
Clinical Applications 26
Chapter 2 - International Development of the Physician Assistant Profession 28
The Netherlands 29
India 29
Germany 29
Saudi Arabia 29
Afghanistan 30
South Africa 30
Case Studies 30
Where Next 34
References 35
Chapter 3 - Education 36
The Mid-1960s through the 1970s—Pioneer Period 37
The 1980s—Maturation Period 40
The 1990s—Boom or Bust Time 43
The 2000s—Moving Forward 46
The Future—What will PA Education Look like Beyond 2010 48
Conclusion 49
Clinical Applications 50
References 51
Chapter 4 - Credentialing: Accreditation, Certification, Licensing, and Privileging 52
Program Credentialing 52
Graduate Credentialing 56
Clinical Applications 61
References 61
Chapter 5 - National Commission on Certification of Physician ­Assistants Specialty ­Recognition: Certificate of Added Qualifications 62
History 63
AAPA and NCCPA 63
Remediation and Retooling 64
Institutional Concerns 64
External Threats 64
National Meeting 64
NCCPA Consensus Points 65
Feedback from the Field 65
Outcomes—Future Plans 66
References 67
Chapter 6 - Financing and Reimbursement 68
Government-Sponsored Programs 69
Private Insurance 73
Conclusion 77
Clinical Applications 77
References 78
Chapter 7 - The Political Process 79
Individual Responsibilities 79
Practice Laws 80
Individuals: Part of the Whole 82
State Legislative Process 84
Federal Regulatory Process 86
State Regulatory Process 87
Case Studies 89
Conclusion 90
Clinical Applications 91
References 91
Section II - Medical Knowlege 93
Chapter 8 - Evidence-Based Medicine 95
What is Evidence-Based Medicine 96
Conclusion 107
Clinical Applications 107
References 108
Chapter 9 - Research and the Physician Assistant 109
Defining Research 110
Medical Literature 115
Conclusion 117
Clinical Applications 117
References 117
Chapter 10 - Safety in Clinical Settings 118
Universal Precautions 119
International Travel 119
Needlestick and Sharps Injuries 119
Tuberculosis Screening 120
Latex Allergy 121
Student Mistreatment 122
Sexual Harassment 122
References 125
Chapter 11 - Clinical Procedures 127
Wounds and Their Treatment 128
Commonly Performed Clinical Procedures 143
Clinical Applications 156
References 156
Chapter 12 - Genetics in Primary Care 157
Genetic Skills Needed in Primary Care 158
Future 166
Clinical Applications 168
Chapter 13 - Chronic Care Perspectives 171
Current Care Shortfalls 171
A New Model of Care 172
Chronic Illness Care Creates a Paradigm Shift: the Patient-Professional Partnership 172
Elements of the Chronic Care Model 172
Motivational Interviewing and Action Planning 174
Support Self-Efficacy 175
Population-Based Management of Chronic Disease 179
Role of the Pa in Chronic Illness Care: an Integration of the Physician Assistant Core Competencies 180
Clinical Applications 183
Chapter 14 - Pharmacology: The Use of Medications 186
Risk-Benefit Ratio 188
Drug Allergies 188
Limiting the Armamentarium 189
Routes of Administration 190
Drug Interactions 191
Safety in Pregnancy 192
Cost-Effectiveness 192
The Prescription 192
Inpatient Orders 196
Dispensing 196
Pharmaceutical Industry 197
Conclusion 198
Clinical Applications 198
References 199
Chapter 15 - Complementary and Alternative Medicine 200
Government Response 201
Prevalence of Use of Cam in the United States 202
Trends 202
Herbals and Supplements 204
Implications for Physician Assistants 206
What PAs should Know When Managing Patients and CAM Use 207
Role of the Physician Assistant 208
Conclusion 211
Clinical Applications 211
References 212
Section III - Interpersonal and communication skills 213
Chapter 16 - Communication Issues 215
Online Communication in Health Care Office Settings 216
Telemedicine 217
Patient-Provider Communication 217
Health Literacy and Intercultural Communication 218
Conclusion 218
Clinical Applications 218
References 219
Chapter 17 - Electronic Health Record 221
Development 221
Implementation 222
Security 224
Clinical Applications 224
References 225
Chapter 18 - Using Consultants and Community Resources 226
Using Consultants 227
Using Community Resources 231
Overview of Typical Community Services 233
Conclusion: Help for the S Family 237
Clinical Applications 237
Section IV Patient Care 239
Chapter 19 - Health Promotion, Disease P­revention, and Patient Education 241
History and Physical Examination 243
Immunizations 244
Barriers to Implementation 245
Patient Education and Counseling 246
Conclusion 247
Clinical Applications 248
References 248
Chapter 20 - Family Medicine 249
Primary Care Concepts 249
Congruence of Family Practice and Internal Medicine 251
Primary Care Incomes 251
Expanding Crisis in Primary Care and Family Practice 252
Partnership Between Family Physicians and PAs 253
History of Family Practice 254
History of Internal Medicine 254
What is Family Practice 255
What Distinguishes Family Practice from Internal Medicine 255
PAs Employed in Family Practice and Internal Medicine 256
Conclusion 263
Clinical Applications 266
References 266
Chapter 21 - Internal Medicine 267
What is Internal Medicine 267
Internal Medicine Practice 269
Typical Internal Medicine Cases 270
References 276
Chapter 22 - Emergency Medicine 277
Principles of Emergency Medicine 278
Problem-Oriented History and Physical Examination 283
The Community 286
Role of the Emergency Department within the Health Care System 287
General Approach to the Evaluation of Abdominal Pain 288
Female with Lower Abdominal Pain and Vaginal Bleeding 291
Management of the Febrile Child Younger Than 2 Years 293
Eye Emergencies 294
Ear, Nose, and Throat Emergencies 297
Neck Pain and Low Back Pain 298
Sprains 300
Miscellaneous Conditions 313
Neurologic and Tendon Evaluation of the Forearm, Wrist, and Hand 315
Wilderness Medicine 317
Miscellaneous Conditions 318
Drug and Alcohol Poisoning in the Emergency Department 319
Legal and Ethical Decisions in Emergency Medicine 321
Special Considerations 322
Clinical Pearls in Emergency Medicine 324
Clinical Applications 326
References 326
Chapter 23 - Pediatrics 327
Historical Perspective 327
Issues in Pediatrics 328
What is the Practice of Pediatrics 329
Choices for Practice 341
Conclusion 342
Clinical Applications 342
References 343
Chapter 24 - Obstetrics and Gynecology 345
Counseling 346
Tasks and Procedures 351
Practice Choices in Obstetrics and Gynecology 354
Conclusion 354
Clinical Applications 355
Chapter 25 - Surgery 356
Learning the Ropes 358
General Overview 358
Assistant in Surgery 359
Judgment, Hands, Tools, and Devices 359
Who’s Who in the Operating Room 360
Preoperative Patient Evaluation 362
Blood and Blood Products 368
Documentation 370
Preparation for Surgery 372
Asepsis and Infection Control in the Operating Room 373
Skin Preparation 376
Surgical Hand Scrub 377
General Preparations 377
Gowning and Gloving 378
Maintaining a Sterile Field 380
Patient Positioning 381
Operative Site Draping and Equipment 384
Surgical Assisting and Instrumentation 384
Minimally Invasive Surgery 393
Surgical Bleeding 397
Concepts for Surgical Assisting 401
Postoperative Care 403
Conclusion 408
Clinical Applications 409
References 409
Chapter 26 - Geriatric Medicine 410
Chronic Conditions 411
Age-Related Changes 413
Geriatric Syndromes 415
Common Problems in Geriatric Care 420
Depression 423
Sexuality and Aging 424
Prostate Disease 425
Unique Issues in Geriatric Care 425
Community Resources and Services 428
Conclusion 430
Clinical Applications 431
References 431
Chapter 27 - Behavioral Science and Medicine: Essentials in Practice 433
Mental Health 434
Structure of the Physician Assistant–Patient Encounter 435
Psychotherapy 436
Supporting Behavioral Change 437
Referral: How and When 439
Mental Status Examination 439
Depressive Disorders 440
Major Depression (DSM-IV 296.2) 441
Anxiety Disorders 442
Discussion 442
Psychotic Disorders 445
Delirium and Dementia 446
Summary 447
Clinical Applications 448
References 449
Chapter 28 - Physician Assistants in Hospital Medicine 450
Scope of Practice 451
Clinical Applications 454
References 455
Chapter 29 - Orthopedics 456
Physician Assistants in Orthopedics 456
Orthopedic History 457
Musculoskeletal Physical Examination 458
Special Orthopedic Tests 458
Common Orthopedic Problems 458
Challenges and Rewards for Physician Assistants in Orthopedics 471
Conclusion 471
Clinical Applications 472
References 472
Chapter 30 - Dermatology 473
History of Dermatology 473
What is Dermatology 474
Clinical Dermatology 475
Conclusion 483
References 483
Chapter 31 - Oncology 485
Patient Care 486
For The Student 487
Salary Ranges 489
Cancer Care 490
Goals of Treatment 491
Clinical Applications 492
References 493
Chapter 32 - Infectious Disease 494
History of Infectious Disease 494
Common Roles of the PA in an Infectious Disease Practice 495
Student Mentoring 496
Problem-Based Clinical Assessment in the Infectious Disease Setting 496
References 503
Chapter 33 - Occupational and Environmental Medicine 505
What Should you Know before you Start the Rotation 505
History of Occupational Medicine 505
Labor Organizations’ Contribution 506
Legislation 507
What to Expect 515
Clinical Applications 522
Section V Professionalism 525
Chapter 34 - Professionalism 527
Elements of the PA Competency of Professionalism 528
Behavior Toward the Patient 529
Behavior Toward other Professionals 530
Behavior Toward the Public 531
Behavior Toward Oneself 532
Fostering Professionalism 532
Conclusion 533
Clinical Applications 533
References 534
Chapter 35 - Clinical Ethics 536
Skills, Competence, and Confidence 537
Character and Virtue 538
Ethics and Morals and Theories 538
Short History of Clinical Bioethics 539
Data to Collect for a Clinical Ethical Analysis 540
How to Collect Data for a Clinical Ethical Analysis 541
Recognition of Ethical Issues in Practice 542
Conclusion 548
Clinical Applications 548
References 549
Chapter 36 - Medical Malpractice and Risk Management 550
Physician Assistant’s Reaction to Notification of a Lawsuit 550
Reasons That Physician Assistants are Sued 551
Commonsense Risk Management Strategies 552
Interpersonal Communications 554
Discovery Rule 554
Medical Malpractice Defined 555
National Practitioner Data Bank 555
Clinical Applications 559
References 559
Chapter 37 - Postgraduate Residency Programs 560
History of Postgraduate Residency Education 561
Association of Postgraduate Programs 562
Appap Membership 562
Residency Program Accreditation 563
Current Available Programs 564
General Characteristics of Existing Programs 564
Resident Perceptions of Training 566
Residency Graduate Employment Opportunities 566
Conclusion 569
Clinical Applications 569
Chapter 38 - Dealing with Stress and Burnout 571
Decision to Become a Physician Assistant 571
Experience of Stress in Training 572
Stress on the Job 574
Burnout 576
Conclusion 578
Clinical Applications 579
References 579
Section VI Practice-Based Learning and Improvement 581
Chapter 39 - Health Disparities 583
What are Health Disparities 585
Health Literacy and its Impact on Health Disparities 585
Health Disparities: Scope of the Problem 586
Clinical Applications 590
References 591
Chapter 40 - Patient Safety and Quality of Care 593
Quality Care Movement in America 593
Types of Medical Errors 595
Patient Safety Strategies 600
Clinical Applications 602
References 603
Chapter 41 - Population-Based Health 604
History 604
What is Population-Based Medicine 605
Prevention of Medical Errors 606
Determinants of Health 607
Premature Mortality 608
Disparity in Health 610
Clinical Applications 613
Summary 614
References 615
Section VII systems-Based Practice 617
Chapter 42 - Health Care Delivery Systems 619
Health Care Systems 620
Integrated Systems 620
Patient-Centered Medical Homes 622
Accountable Care Organizations 623
Implications for Physician Assistants 623
Recruitment/Hiring/Employment Issues 623
State and Federal Regulations 624
Reporting Patterns 624
New Delivery Systems—Medical Homes 624
Planning for the Future 625
Conclusions/Projections 625
References 628
Chapter 43 - Rehabilitative and Long-Term Care Systems 629
Home Care—Informal Caregivers 630
Home Care—Home Care Organizations 631
Hospice 631
Medical House Calls 632
Assisted-Living Facilities 633
Nursing Homes 633
References 634
Chapter 44 - Health Care for Homeless Populations 636
Adults 637
Pediatrics 638
Adolescents 639
Military Veterans 639
Conclusion 640
Clinical Applications 641
References 642
Chapter 45 - Correctional Medicine 643
Working in a Correctional Environment 644
Providing Health Care in Correctional Institutions 644
Staffing in Correctional Medicine 646
Communicable Disease in Correctional Institutions 648
Chronic Disease in Correctional Institutions 652
Managing Mental Health in Correctional Institutions 654
Special Issues in Corrections 655
Managing Ethical Conflicts in Correctional Institutions 656
Future Directions 658
Conclusion 658
References 660
Chapter 46 - Military Medicine 662
Scope of Practice 664
Role of Physician Assistants in the Military 665
Cost-Benefit Analysis 666
Clinical Applications 667
Chapter 47 - Inner-City Health Care 668
Can you Answer These Questions 668
What do we Mean by Inner City 669
Diversity in the Inner City 670
Health Disparities 670
Health Care in the Inner City 671
Recent Trends in the Inner City 671
Role of Public Teaching Hospitals 671
Role of Public Health Departments 672
Role of Community Health Centers 672
Increasing Complexity of Inner-City Practice 673
Unique Health Concerns 674
The Children, the Future 675
References 676
Chapter 48 - Rural Health Care 678
What is Rural and why Does it Matter 678
Characteristics of Rural Populations and Communities 679
Rural Demographics 680
Access to Health Care 682
Rural Clinics: Frontline Access 686
Funding and Reimbursement for Rural Health Services 688
Rural Health Workforce Issues 689
Physician Assistants and Rural Medicine 690
Requisites for a Rural Physician Assistant 692
Challenges and Rewards of Rural Practice 693
Clinical Applications 693
References 694
Chapter 49 - International Health Care 696
Practical Considerations 697
Qualifications 699
Other Considerations 700
Clinical Applications 704
Chapter 50 - Patients with Disabilities 705
Providing Appropriate Care for Patients who are Deaf and Hard of Hearing 706
Providing Appropriate Care for Patients with Mobility Disabilities 709
Providing Appropriate Care for Patients with Visual Impairments 712
Providing Appropriate Care for Patients with Intellectual and Developmental Disabilities 714
Clinical Applications 716
References 717
Chapter 51 - End-of-Life Issues 718
Truth-Telling 718
Helping Patients Make Informed Decisions 719
Planning for Death 719
Emerging Issues 720
Advance Directives 720
Hospice 721
Having the Conversation 722
Stages of Dying 723
Stages of Grief 724
Clinical Applications 724
References 725
Chapter 52 - Mass Casualty and Disaster Management 727
Physician Assistants as Educators 727
Physician Assistants as Providers 729
Physician Assistants in Aftercare 730
Long-Term Effects 730
Special Populations 730
Physician Assistants in Policy 731
Physician Assistant Training for Disaster Response 732
Summary 737
Clinical Applications 737
References 738
Chapter 53 - Physician Assistants and Supervision 739
Historical Perspective 740
Shared Knowledge Base 740
Dependent Practice Versus Interdependent Practice 740
Communication, Coordination, and Continuity of Care 741
Delegated Scope of Practice 741
Autonomous Medical Decision-Making 742
Agency Relationship 743
Supervision 743
Flexibility in Supervision 745
Practice Ownership 746
Summary 747
Clinical Applications 747
References 748
Appendix - Competencies for the Physician Assistant Profession 749
Preamble 749
Introduction 749
Medical Knowledge 749
Interpersonal and Communication Skills 750
Patient Care 750
Professionalism 750
Practice-Based Learning and Improvement 751
Systems-Based Practice 751
Index 753
IBC IBC