As a physician assistant (PA), your patient interactions are personalized and an integral aspect of the primary care practice’s approach to patient care. Patient appointments may run the gamut from same-day visits to treating patients with more chronic conditions.
During patient appointments, you initiate in-office tests to broaden your diagnosis methodology. After receiving test results, you might need to collaborate with a doctor. Consider these guidelines on whether that kind of collaboration is warranted.
Recommended Protocols
In primary care, PAs see patients for the same kinds of issues as any frontline provider, everything from same-day appointments for rashes, coughs, or flu symptoms to ongoing management of chronic conditions such as high blood pressure or diabetes, said Jensen Lewis, MSPAS, PA-C, program director and associate professor at Case Western Reserve University School of Medicine in Cleveland. “PAs are trained and licensed to evaluate, diagnose, and treat patients — including prescribing medications,” he said.
If a patient’s blood pressure is high, for example, the PA can explain what that means, order or adjust medication, and create a plan for follow-up.
“It is both appropriate and expected that they answer patient questions about in-office tests such as EKGs, blood pressure checks, or other point-of-care tests,” said Lewis. “In fact, part of the PA’s role is to interpret and explain these results in real time, ensuring patients understand what the test means for their health.”
Of importance is that PAs work as part of a collaborative team. So if a question requires input from a physician or if the test results tie into a broader care plan, PAs will often explain the results and answer questions immediately and then reinforce or expand on that information together with the collaborating physician.
“The goal is to provide clear, timely, and accurate information so patients feel informed and cared for, while also practicing within the collaborative framework of the healthcare team,” Lewis said.
Dealing With Patients Who Are Anxious About Test Results
To ease the emotions of patients, normalize their experience of feeling anxious/nervous by explaining what the test does and why it’s important.
“The goal is to frame the test as an act of prevention and reassurance, not alarm,” said Lewis.
Another approach is to respond with empathy. And if abnormal test results are discovered, PAs are trained and licensed to manage these abnormalities, Lewis said.
“PAs can consult the collaborating physician or refer the patient to any subspecialist, such as a cardiologist, for further workup. The PA’s role, however, is to explain what is known, what is being done next, and offer an explanation as to why.”
How Body Language Influences Patient Experiences
Building patient rapport is paramount to creating and maintaining trust with patients. It could be helpful to incorporate patient-centric approaches.
“For example, PAs should avoid the use of medical jargon — use ‘high blood pressure’ instead of ‘hypertension,’” said Lewis.
Also, he said, PAs should sit at eye level with the patient. “This communicates respect and attention,” Lewis said. It’s also important to acknowledge the patient’s emotions. “Patients want a provider to listen to them; listening to patients invites their input. Patients respond to authenticity and presence.”
If a Diagnosis Is Beyond the Treatment Scope of a PA
Trust and transparency are key in the patient-provider relationship. “It is OK for PAs to pause when something is outside of their scope and need further input,’ said Lewis.
To that point, a PA should explain results to patients to the degree one is comfortable and competent, and in alignment with clinic protocols, said Deborah L. Schofield, PhD, DNP, CRNP, senior nurse practitioner for population health at the University of Maryland Medical Center, chair of advanced practice providers at the University of Maryland Medical System, and an associate adjunct professor at the University of Maryland School of Nursing, all in Baltimore.
Explaining “your blood pressure is high/normal” or “your rapid strep test is positive/negative, so here is what we’ll do” is usually within the PA’s role, Schofield said. However, for more complex interpretations such as “subtle EKG findings, borderline results, or results that raise significant red flags, the PA may elect to involve the collaborating physician, refer to them, or at least consult before communicating a definitive conclusion if uncertain.”
Thus, a PA doesn’t have to defer everything to the physician, but they must stay within what they are educated, trained, and delegated to do and collaborate as needed, she further said.
Handling Referrals to a Specialist
The PA should determine if they are comfortable referring a patient to a specific specialist. If they are, they should and may move forward in doing so.
“PAs regularly coordinate referrals to specialists like cardiologists, gastroenterologists, or pulmonologists, and in most practices, PAs generate and submit these referrals directly,” said Lewis. “The PA remains the point of contact, helping to interpret results and coordinate ongoing care once the specialist provides input.”
If a PA is seeking additional insight or a second opinion for a referral, they can consult with the physician as needed.
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