Issues Exam 1

Major changes in the healthcare system

Health insurance - early 1900’s

Medicare/medicaid- 1965

expansion of preventive medicine- vaccines, life style, screenings, prenatal care

evidence based medicine

electronic health records

Identify key 20th century legislation that has transformed the healthcare system.

medicaid/medicare-1965

HIPPA - 1996

affordable care act - 2010

Describe five of the most important medical advances of the last 150 years, when they occurred, and why they were important.

• Germ theory - 1860-1880

• Vaccines - late 1800-20th

• Antibiotics - 1920-2940

• Imaging - 1895

• Transplantation - 1950s

1800s treatment

• Bloodletting

• Purging

• Limited understanding of infection

• Surgery was extremely dangerous because anesthesia and infection control were limited.

Late 1800s–early 1900s treatment

• Germ theory

• Better sanitation

• Sterilization

• Anesthesia

• Improved surgical techniques

Mid-1900s treatment

• Antibiotics

• Vaccines

• Blood transfusions

• Improved surgery

• New diagnostic technologies

Late 1900s–today treatment

• Evidence-based medicine

• Prevention

• Early diagnosis

• Less-invasive treatments

• Patient safety

• Patient preferences/shared decision-making

• Chronic disease management

• Quality of life

flexner report

published in 1910 by Abraham Flexner, evaluated medical education in the United States and Canada. It led to major reforms in how physicians were educated.

key components of the flexner report

• Higher admission standards

• Science-based medical education

• Two-phase curriculum

  • Preclinical education: Basic sciences in the classroom/laboratory.

  • Clinical education: Hands-on training with patients in hospitals.

• Laboratory and clinical training

• Higher standards for medical schools

positive impacts on medical education from the flexner report

• Medical education became much more standardized and science-based.

• Increased emphasis on laboratory science and clinical experience.

• Improved the quality and consistency of physician training.

• Helped establish the modern medical-school curriculum

negative impacts on medical education from the flexner report

The reforms contributed to the closure of many medical schools, disproportionately affecting schools serving Black students and women. The number of medical schools training Black physicians declined substantially, and opportunities for Black medical students became much more limited.

Discuss the historical development of the PA profession.

1960s — PA profession begins

• The PA profession was created in response to a shortage and uneven distribution of physicians, especially in underserved areas.

• Dr. Eugene A. Stead Jr. at Duke University developed the first PA program.

1965 — First PA class

• Duke University's first PA class began in 1965..

1967 — First PA graduates

1970s — Profession expands

1970s–1980s — Certification and regulation

• The profession developed standardized education, certification, and licensing processes.

• The NCCPA (National Commission on Certification of Physician Assistants) was established in 1974.

• The PA-C credential became the standard certification.

1990s–2000s — Expanding scope

Describe by whom, when, and where the PA profession was founded

• Who: Dr. Eugene A. Stead Jr.

• When: 1965 — the first PA class began

• Where: Duke University in Durham, North Carolina

• First graduates: 1967

By when were PAs licensed practitioners in all 50 states?

1994

AAPA

American Academy of Physician Associates

Represents and advocates for PAs nationally. Works on legislation, policy, professional issues, and public awareness.

NCCPA

National Commission on Certification of Physician Assistants

Certifies PAs. Administers the PANCE and maintains certification through continuing certification requirements.

ARC-PA

Accreditation Review Commission on Education for the Physician Assistant

Accredits PA programs. Makes sure PA educational programs meet established standards.

PAEA

Physician Assistant Education Association

Represents PA educators and PA educational programs. Supports faculty development, educational research, and resources for PA education.

Optimal Team Practice

is the AAPA's concept that PAs should be able to practice as part of a physician-PA team without laws requiring a specific supervisory agreement or mandated physician-to-PA ratio.

PA and physician should determine how they work together based on the needs of the patient, practice, and community, rather than having every detail dictated by state law.

Discuss the ramifications of the concept of Optimal Team Practice

• Greater flexibility

• Improved access to care

• Reduced administrative burden

• Team-based care

• State-by-state differences:

• Debate over physician oversight: Supporters view OTP as reducing unnecessary restrictions; opponents have raised concerns about maintaining appropriate physician involvement and patient safety.

Define health literacy

is a person's ability to find, understand, evaluate, and use health information and services to make appropriate health decisions.

List five specific things you can do to assist a patient with low health literacy to be able to better care for their health.

• Use plain, simple language – Avoid medical jargon and explain terms in everyday language.

• Use the teach-back method – Ask the patient to explain the instructions back to you in their own words.

• Use pictures or demonstrations – Visual aids can make instructions easier to understand.

• Give clear, written instructions – Use short sentences, bullet points, and easy-to-read materials.

• Encourage questions – Create a comfortable environment where the patient feels safe asking for clarification.

Describe which groups of individuals are most likely to have low health literacy

• Older adults

• People with lower levels of education

• People with limited English proficiency

• People with lower socioeconomic status

• People who have limited access to healthcare

• People who are new to the U.S. healthcare system

describe the impact of low health literacy can have on health.

Low health literacy can make it harder for patients to:

• Understand medical information and instructions

• Take medications correctly

• Follow treatment plans

• Understand when and where to seek care

• Navigate the healthcare system

• Make informed healthcare decisions

This can lead to more medication errors, poorer management of chronic diseases, lower use of preventive services, increased emergency/healthcare utilization, and worse overall health outcomes.

media literacy

The ability to access, analyze, evaluate, and create information communicated through media.

Can I determine whether the information I'm seeing in the media is credible, accurate, or potentially misleading?

List techniques that result in the effective exchange of information and collaboration with patients, particularly when low levels of health literacy are a concern.

• Use plain language

• Speak slowly and clearly

• Limit the amount of information

• Use the teach-back method

• Use visual aids and demonstrations

• Ask open-ended questions

• Encourage questions

• Use culturally appropriate communication

• Provide easy-to-read written instructions

• Involve the patient in decisions

Discuss growing levels of "health skepticism" and misinformation in the United States

is increasing distrust or doubt toward medical information, healthcare professionals, or health institutions. At the same time, health misinformation—false or inaccurate health information—is widespread, particularly through social media and online sources.

• Make decisions based on inaccurate information

• Delay appropriate medical care

• Refuse beneficial treatments or preventive care

• Use ineffective or potentially harmful treatments

• Lose trust in healthcare professionals

• Have difficulty distinguishing reliable information from misleading information

manners in which to address health skepticism

• Build trust

• Ask what the patient has heard

• Provide clear, evidence-based information

• Correct misinformation respectfully

• Teach media and health literacy

• Use the teach-back method

Cura Personalis.

Jesuit education emphasizes the view that each person is a unique creation of God. Cura Personalis (meaning ‘care for the whole self’) is demonstrated by personal attention in the classroom, a deep respect for diversity and difference and an emphasis on holistic care for the mind, body and spirit.

Men and Women for and with Others

We must become “people who cannot even conceive of love of God which does not include love for the least of their neighbors.” A Jesuit education encourages students to integrate contemplation and action, so they become men and women with well--developed minds, generous hearts and reflective souls — “agents of change” who work to bring about a more just, humane world.

Discernment

Discernment is a process for making choices, in a context of faith, when the option is between several possible courses of action, all of which are potentially good. For Ignatius, discernment involved prayer, reflection and consultation with others—all with honest attention not only to the rational, but also to the realm of one’s feelings. encourages students to be open to God’s spirit as they make decisions and take actions that contribute to the greater good. Discernment is practiced through prayer, reflection, consultation with others and considering the full impact of actions from

diverse angles.

Finding God in all things

A Jesuit education is one grounded in the presence of God, and encompasses imagination, emotion and intellect. The Jesuit vision encourages students to seek the divine in all things—in all peoples and cultures, in all areas of study and learning and in every human experience

Magis

A commitment to the concept of Magis (Latin for ‘more’) is a hallmark of Jesuit education. It challenges students to go beyond what is expected, interacting with the world with generosity, excellence and empathy. Magis is modeled by personal accountability and high expectations of achievement.

Reflection

A foundational value of Jesuit education is the practice of reflection. Students are invited to pause to consider the world around them and their place within it before making decisions. This includes challenging the status quo, acknowledging biases and accepting responsibility for actions.

Describe the elements of effective communication.

• Active listening

• Clear and concise language

• Empathy and respect

• Open-ended questions

• Nonverbal communication

• Confirm understanding

• Encourage questions and feedback

• Cultural awareness

• Professionalism

• Collaboration

Identify steps to develop patient-practitioner rapport

• Introduce yourself

• Address the patient appropriately

• Create a comfortable environment

• Use active listening

• Show empathy and genuine interest

• Use open-ended questions

• Maintain appropriate nonverbal communication

• Be honest and trustworthy

• Involve the patient in decisions

• Check understanding

Identify steps to improve communication with other health professionals

• Communicate clearly and concisely

• Practice active listening

• Use professional and respectful language

• Share important patient information

• Use standardized communication tools

• Clarify information

• Confirm understanding

• Respect each professional’s role and expertise

• Provide and accept constructive feedback

• Work toward a shared goal

Describe different types of challenging patient encounters

reticent

anxious

depressed

demanding-dependent-manipulative

rambling

controlling

dramatic

masochistic

guarded-paranoid

superior

somatization

denial

reticent patient

volunteer very little information

answer open ended questions with few words

approach to reticence

engage small talk

be respectful and unhurried

open ended questions

use empathetic statements

rely on nonverbal cues

anxious patient

can be over talkative or reticent

tends to exaggerate the patients usual personality style

what to do with an angry patient

recognize and acknowledge anger

listen and be nonjudgmental

dont argue back

explore contributing factors

accept their reason for being angry even if you disagree

dont make excuses

acknowledge mistakes

what to do with the depressed patient

acknowledge depression

check for suicidal/homicidal ideation

offer practical plans for support

use open ended questions

take time

document

how to deal with a rambling patient

limited time but let them know you have a plant to address their other concerns

observe real reason for visit

stop and redirect gently

take conversation back on track

somatization

patient with multiple vague complaints

discuss the possibility that they will accept it if you tell them there is no terrible thing causing their symptoms

Discuss acute versus chronic illness

Acute Illness	Chronic Illness
Begins suddenly	Develops slowly or may persist over time
Usually short-term	Long-term, often months to years
Often has a clear onset	May have a gradual or unclear onset
Usually resolves with treatment or the body heals	Often requires ongoing management
Example: pneumonia, appendicitis, influenza	Example: diabetes, hypertension, asthma

Recognize the needs of the grieving person

• Emotional support and empathy

• Time and space to grieve

• Someone who will listen without judgment

• Validation of their feelings

• Respect for cultural and religious beliefs

• Clear and honest communication

• Support from family, friends, or community

• Help with practical needs and daily responsibilities

• Opportunities to talk about the person who died

• Professional counseling or other support when needed

Evaluate cultural issues in grief response

• Recognize that grief varies between cultures

• Respect cultural beliefs and traditions surrounding death

• Understand differences in funeral and burial practices

• Respect religious and spiritual beliefs

• Recognize different ways emotions may be expressed

• Avoid assuming that everyone grieves in the same way

• Ask about the patient’s cultural and religious preferences

• Respect family roles and decision-making practices

• Use culturally appropriate communication

• Provide culturally appropriate emotional and spiritual support

Identify barriers in communicating “bad news.”

• Fear of causing emotional distress

• Patient denial or disbelief

• Strong emotional reactions

• Language barriers

• Cultural differences

• Health literacy limitations

• Religious or spiritual beliefs

• Lack of trust in the healthcare professional

• Medical jargon or unclear explanations

• Lack of privacy or an appropriate setting

• Time constraints

• Healthcare professional discomfort or lack of experience

• Family disagreements about disclosure

• Misunderstanding or miscommunication

• Unrealistic expectations about the diagnosis or prognosis

Discuss compassion fatigue.

is physical, emotional, and mental exhaustion that can occur from repeatedly caring for people who are suffering or experiencing trauma.

What causes compassion fatigue

• Repeated exposure to patient suffering, trauma, or death

• Heavy workload and long hours

• Emotional demands of patient care

• Lack of work-life balance

• Poor support from coworkers or the organization

• Difficulty maintaining emotional boundaries

• Personal stress occurring alongside work stress

how to protect yourself from compassion fatigue

• Practice self-care

• Get adequate sleep, nutrition, and exercise

• Maintain healthy work-life boundaries

• Take regular breaks

• Develop supportive relationships with coworkers, friends, and family

• Talk about difficult experiences rather than bottling them up

• Use counseling or other professional support when needed

• Practice stress-management and relaxation techniques

• Recognize early warning signs of burnout or compassion fatigue

• Maintain activities and relationships outside of healthcare

the four main bioethical principles

autonomy

beneficence

nonmaleficence

justive

autonomy

self rule

patients have the right to make autonomous decisions and choices and PAs should respect those decisions and choices

beneficence

act in the patients best interest

nonmaleficence

do no harm

impose no unnecessary or unacceptable burden upon the patient

justice

patients in similar circumstances should receive similar care

applies to norms for the fair distribution of resources, risks, and costs

Ad majorem dei gloriam

AMDG

for the greater glory of God

means that even the smallest gesture can be done to glorify God

cura personalis

care for the individual person

describes respect for the dignity of each person as a child of God

educating the whole person

learning through contact not just concepts

first hand experience, service learning, outreach

finding God in all things

seek to find God in all things

divine revelation, the natural world, human experience, and every academic discipline that explores these orders of knowledge

Identify professional ethics core to a 21st-century approach to clinical care

1. Respect for patient autonomy

2. Beneficence

3. Nonmaleficence

4. Justice and fairness

5. Respect for human dignity

6. Confidentiality and privacy

7. Honesty and integrity

8. Accountability

9. Professional competence

10. Cultural humility and respect for diversity

11. Patient advocacy

12. Informed consent

13. Professional boundaries

14. Commitment to evidence-based care

15. Collaboration and respect for other healthcare professionals

Discuss current ethical issues around fertility and reproduction

• Access to reproductive healthcare – Differences in access to contraception, fertility treatment, prenatal care, abortion, and other reproductive services.

• Abortion – Ethical questions surrounding patient autonomy, fetal interests, medical care, and differing moral or religious beliefs.

• Assisted reproductive technology (ART) – Ethical concerns involving IVF, including cost, access, embryo creation, storage, donation, and disposition.

• Embryo selection and genetic testing – Questions about selecting embryos based on genetic conditions and the potential for selecting other characteristics.

• Surrogacy – Concerns about informed consent, compensation, exploitation, and the rights of the intended parents, surrogate, and child.

• Donor eggs and sperm – Issues involving donor consent, anonymity, genetic information, and the future child's right to know their biological origins.

• Fertility preservation – Ethical questions surrounding egg/sperm freezing, particularly for patients undergoing cancer treatment or other medical procedures.

• Reproductive autonomy – The patient's right to make informed decisions about whether and when to have children.

• Genetic counseling and reproductive testing – Balancing reproductive choices with concerns about disability, discrimination, and potential psychological effects.

• Equity and discrimination – Differences in access to reproductive services based on income, race, geography, age, disability, marital status, or sexual orientation.

• Emerging reproductive technologies – Ethical questions surrounding technologies such as gene editing and artificial reproduction as they develop.

Apply the Guidelines for Ethical Conduct for the PA Profession to a scenario

• Patient welfare – Put the patient's health and well-being first.

• Patient autonomy – Respect the patient's right to make informed decisions about their care.

• Beneficence – Act in the patient's best interest.

• Nonmaleficence – Avoid causing unnecessary harm.

• Justice – Treat patients fairly and equitably.

• Confidentiality – Protect the patient's private health information.

• Informed consent – Make sure the patient understands the risks, benefits, and alternatives before treatment.

• Professional competence – Practice within your knowledge, skills, training, and scope.

• Honesty and integrity – Communicate truthfully and accurately.

• Professional relationships – Respect and collaborate appropriately with other healthcare professionals.

• Patient advocacy – Advocate for the patient's needs and access to appropriate care.

• Professional responsibility – Follow laws, regulations, and professional standards.