During my Family Practice clinical rotation at Benson Area Medical Center, I had the opportunity to interact with several different professions involved in the healthcare team. I primarily worked with a physician assistant, but many of the other people I interacted with on a daily basis included doctors, nurse practitioners, pharmacists, nurses, medical assistants, phlebotomists, radiology technicians, and other ancillary office staff vital to delivery of effective patient care.
During one week on this rotation, I got to work closely with the resident pharmacist, as well as two Campbell University pharmacy students. During these days, my role as a physician assistant student changed from seeing my own patients and reporting back to my primary preceptor, to becoming part of a team to come up with a plan for a patient, as well as to aid in providing counseling on diabetes diet and medication management. The following are some examples of how I participated in the team of a pharmacist and pharmacy students:
- We saw patients who were referred by other providers in the practice to counsel them on diabetes. This primarily involved dietary counseling, but also involved pharmacologic counseling regarding what their medications did, and how to properly take their medications. My primary role in this type of team encounter was to take a brief history from the patient, as well as obtain vital signs and offer any additional counseling points (especially regarding dietary modifications) that I deemed appropriate. The pharmacist and the pharmacy students also assisted in taking the history, as well as reconciled the patient’s medication list and ensured the patient was competent in administering their own medications, particularly for insulin.
- Providers in the practice would sometimes contact us with a complex patient that they were concerned might be experiencing adverse medication effects or interactions, and would ask us to come up with recommendations on any medication changes or other diagnostic approaches to address the adverse event.
- One particular example was a patient with newly elevated lipids and elevated liver function tests. The primary concern was starting a statin in this patient, but making sure this would be okay given his elevated LFTs, and ensuring that no other medications would interact with each other or were currently worsening his liver function. I discussed the patient’s extensive medication list with the pharmacy students, and they identified a couple of medications that could be causing the elevated LFTs. In addition to their identifying some potential medication changes, I came up with a diagnostic plan to evaluate for any other organic cause for the elevated LFTs. Together, we presented these suggestions to the provider, who agreed to consider the medication changes, as well as initiating the appropriate diagnostic work-up.
- In addition to these interactions, I also worked with this pharmacy team to help with anticoagulation management. Every day, several patients would come to the clinic to have their PT/INR checked to ensure therapeutic anticoagulation with warfarin. As the pharmacy team was responsible for making dose adjustments based on the PT/INR at this practice, I had the opportunity to learn the proper protocols of warfarin management, as well as take on my own patient case load to allow the pharmacy team to see these patients more efficiently.
This rotation site provided me with many opportunities not only to work directly with other providers, but also to learn alongside fellow Campbell University CPHS students. This experience highlighted that as a future physician assistant, much of my ability to provide effective, efficient care will depend on my ability to understand the roles of everyone on my team, as well as my ability to effectively collaborate with everyone in these differing roles.
Campbell Clinical Rotation