Hematology Case

Hematology Case 2_2014(No Audio).Ppt(1)

https://drive.google.com/file/d/0BySYjE1QC42nMHhCeWczcGpaY0E/edit?usp=sharing The link for the hematology case presentation

Read more

PA’s bring benefits to the physicians

Couple of decades ago in the United States, Physician assistants are called as “Physician associate”. According to the merriam-webster dictionary associate means “to join as a partner, friend, or companion”. It is a term which perfectly suits a PA. Because, PA’s are not only a helper of a Physician, they bring lots of benefits to them. Associate term dedicated to a person who helps and also brings benefits to their peers, which a PA do in a day to day basis. There are a couple of ways PA’s bring benefits towards a Physician. They ease the doctor’s workload; they increase cost-effectiveness of the health care system and most-importantly, PA’s increase patient satisfaction.

 One of the greatest advantages of involving PA’s in the practice is that a PA can decrease the physician’s workload to an extreme satisfactory level. While physicians are busy with the complex cases, PA can manage all other necessary things like rounds, calls, office visits etc. They also can manage the walk-ins, routine follow-ups etc. They also can provide emergency care like splinting, bandages. PA’s are flexible, too. They acquire, strong clinical education, so they can work in any fields of the Medicine, which is a unique thing if you compare to the other profession. According to the American Medical association’s socioeconomic survey, practiced physicians experienced increased practice, efficiency and patient care when they hire a physician assistant. Physicians can work one week less on average but their income increased by 18% in the same time, which is a very encouraging statistic for a physician.

Physician assistants are cost-effective, too. Cost-effectiveness is a different thing to measure. But there are certain passive ways where we can determine the cost-effectiveness. If physician assistants can decrease the wait-times of a patient, then more patients can be seen, hence it increases cost-effectiveness. There are a couple of studies indicates that, physician assistants can decrease the patient’s waiting period dramatically. The studies also showed that, PAs increased service quality, helped practices to improve access, provided high quality care, the addition of PAs to a health care team increases patient flow and reduces wait times; there are also a lower proportion of patients leaving the ED without being seen. According to another study done by Hooker in 2002, Physician assistants do not require additional resources for more return visits to manage the episode of care. A Canadian study done by Canadian Orthopaedic Association’s National Standards Committee on the costs and effects of hiring three orthopedic clinical assistants gave an excellent result. They found that, hiring of these PA’s decreased wait times by 32%. Physician assistants are trained in the same model at which physicians are trained. But their salaries are way lower than the physicians. This is a simple tool to determine the cost-effectiveness. If you are getting the same results in the primary care by both of the professions, why you should pay more? A question for the top authority who create plans for the patients.

Finally Hiring a PA increase the patient satisfaction, too. Diminished wait-times have a direct link to the patient satisfaction. If I am being a patient and sit in the waiting room for hours only for the follow-up, I will have a bad impression about the health-sector. Another thing is, not every physician can be available to every patient all the time. So, physician assistant can increase the continuity of the care. Patient compliance can be enhanced by a service of a PA, too. PA can be a good patient educator, too. He can be a part of an important role in nutrition and exercise program, smoking cessation program, etc. Those programs are time killer to a busy physician, so a PA give time in those programs for a patient increase patient satisfaction and belief towards a health care system.

All in all, a Physician assistant has a vast medical education, commitment and flexibility to the patient care. PA’s can increase revenue, give more job satisfaction to a physician, while at the same time, they increase patient satisfaction. I am going to end with a quote made by a family physician in Family practice management, “the PA makes himself invaluable by smoothing the ebbs and flows of our daily workload…..we wonder how any practice can thrive without one.”

Read more

Patient Encounter Reflection

Objective: On a Snowy morning of March fifth, I headed towards the Mount Sinai Hospital Toronto to shadow Jeff Straw; he is a physician assistant working there for last our years. I started at eight O’clock in the morning. Jeff straw works in the emergency department under the supervision of the emergency doctor. But he deals with every patient individually and builds up the management plan on his own and then he consults with the supervising physician. My day started with an old lady came with wrist pain due to the fall in the ice. Jeff ordered X-ray and X-ray results showed small crack in the bone. So, with the supervising doctor’s consultation, Jeff applied wrist cast and gave some medications. It was a very good start for me to start with observing a procedure. In the rest of the day I watched two psychiatric patient, a pancreatitis patient, a patient with rectal bleeding (I observed DRE), a terminal ill patient who is suffering from end stage metastatic cancer. I also saw a very complicated case where the physicians were confused with the diagnosis. I am going to describe about this encounter as I found this one is very interesting and exciting.

The patient was around sixty years of age came with the complaints of low back pain.

I forgot his name, so I will name him as Mr. X. Jeff first checked in the computer about

which patient is in the line and then he went to take the history. Patient described his

pain and informed us that, he had lymphoma long time ago. Then my preceptor Jeff did

all kind of physical examination and wrapped up the history taking part. The patient’s

pain wasn’t looked like a renal pain, although Jeff kept this one as a differential. He

was mainly thinking about the mechanical low back pain due to some kind of stretching.

Next, Jeff went to his supervisor to inform him about the patient. The supervising

physician accepted Jeff’s idea but also he couldn’t rule out the possibility of renal colic.

So, he told Jeff, he is going to check the patient. In the meantime, Jeff ordered CT scan

for the patient. Then Jeff went to the computer to check the details of the patient, where

we received a shock!! The patient had a prostate cancer earlier and he was under

chemotherapy! He didn’t mention anything about this in the history. Suddenly the whole

perspective was changed. Jeff ran to his supervisor to inform him about recent breaking

news and he got another breaking news there. The radiology department denied to

performing the CT-scan on the patient due to the lack of the clinical reasoning. In reply,

the supervising physician has already ordered X-ray of the kidney region. When he got

recent the news of the patient, he also got shocked. Now, the possibility of a dangerous

situation arises, where patient might be in terminal stage with bone metastasis of

the cancer. So, he ordered CT-scan again. Mr. X already moved to the radiology

department again for the X-ray and we had to give him the news when he comes back.

The bad thing is he needs to move for the CT-scan again. So, Jeff was worried about

the reaction of the patient. But, the next part went very smoothly, Mr. X didn’t reacted

and he told us that, he forgot about the prostate cancer. So, we got relieved and moved

to the next case.

My Thoughts and feelings: I was really excited from the beginning of my shift. As, it

was my first emergency room experience in Canada, I was really keen to know about

the system. Fortunately, I got some good cases to see, Mr. X’s case was one of them.

From the beginning of the encounter, I never thought about the renal colic as patient

wasn’t looked agitated about the pain. I knew that, the pain from renal colic is always

excruciating. So, I was also thinking in the same line with Jeff. I also got shocked to see

his past history of prostate cancer. Usually patients never forget anything like that. So,

on that time I also thought if the patient is suffering from Dementia. I never told to my

preceptor about that, because I wasn’t too sure to talk about this matter. I was also little

frustrated to see how the patient was moved to the diagnostics couple of time. If I was

the patient, I would definitely become agitated. But all in all, I felt really proud about that,

the discovery about prostate cancer and the final decision about this patient was came

from a physician assistant.

Evaluation: all well that ends well. Although the whole clinical experience about this

patient had some ups and down, the final outcome is always important and for this

patient I hope it is a good one for him. Fortunately we were able to discover the past

history and changed the whole management plan. If not, it might be a disaster.

Analysis: I am going to divide my analysis in two parts, one for this patient encounter

and other one for the whole day.

As a whole;

• 1. I had very little knowledge about the Canadian hospital’s emergency care. Now I
• have a very clear picture about how the system works. It begins with a triage nurse.
• If it is simple case, then it ends with the PA, NP or the emergency doc. If it became
• complicated after some lab works, then the patient being referred to the inpatient
• department
• 2. Jeff was really helpful. He introduced me to every physician, and they were also very
• helpful towards me.
• 3. One important point, although Jeff was able to prescribe medicine and order tests,
• but before every decision, he had to consult with his supervisor. Sometimes it became
• really frustrating.
• 4. There were no medical directives for the PA’s yet made in Mount Sinai. However,
• Nurses has some medical directives.

For this encounter,

• 1. I also noticed sometimes it is frustrating to consult about every step with the supervising physician. I asked Jeff about that, he told me as he has no medical directives to work; he has to follow this rule.
• 2. Jeff spent enough time with the patient but still wasn’t able to extract an important history from the patient. When he checked the full past history in the network, he was able to find it. So, it is very important to keep all records up-to- date in the all hospital network system.
• 3. It is also important to build a good link with the family physicians.
• 4. The scope of physician assistants is not the same in all hospitals. So, some work should be done to build some permanent thing.

Action Plan: In conclusion, I am really happy about the whole encounter. I was able

to feel some heats from the emergency department. On the other hand, I was really

motivated to work on this field. For the rest of the semesters, I would definitely do more

clinical encounters like this one.

Read more

Personal profile

Hi, I am Sarwar Ibn Kaiser. I am from Toronto, Ontario.

I am an emerging Physician Assistant; currently enrolled in the Physician Assistant Professional Degree Program in the Faculty of Medicine at the University of Toronto. 

Healthcare background: I am an International medical graduate, graduated from medical school in 2009. I have completed my clinical rotation in 2010 and worked in several medical clinics on that period. During my clinical rotation, I had to do various works in each Department. When I worked in Medicine, every morning I had to follow-up each patient of my ward. Then I had to present my case to the professors and complete their orders. In Night shifts, I was the only person who had to manage the whole ward. I did same thing in the other departments. In addition to this, I assisted professors and my seniors in various surgeries and attended normal vaginal deliveries.

I Immigrated to Canada in January, 2011 and started to search a position for myself in the Canadian health care system. To pursue my goal, I started diploma in Opticianry at Seneca College in September, 2012 and became a Registered Student Optician under College of Opticians of Ontario. I worked with two Optometrists in that period. I helped in patient preparation by taking auto-refractometer and tonometer readings. I also had to dispense eyeglasses and contact lenses under Optician supervision.

As a Physician Assistant, I have to work as a physician extender. I have to deal with some challenging situations. Also, I have to be a good model for the future PA’s. I think my health-care backgrounds gave me a solid base to be an effective Physician Assistant in the future.

Academic Background: MBBS from North-East Medical College under school of Medicine at Shahjalal University of Science and technology, Sylhet, Bangladesh. I also studied at the Seneca College in the Diploma in Opticianry.

Career Goals: 

• To become a professional, respected, most competent and compassionate physician assistant.·        
• To be a life-ling learner and a highly educated PA.·       
• To build an excellent relationship with my patients and my supervising Physician.·        
• I want to be the best advocate for the PA profession in Canada.·        
• I am mostly interested in internal medicine. Although I am looking forward to determining my ultimate career goals through second year clinical rotations.·        
• I also have a strong desire to volunteer for underserved populations around the world especially my back home where so many peoples are suffering every day.·       
• Finally, I want to develop myself as an individual and become the person I always envisioned I would be through professional and spiritual ways. 

Myself as a Learner:  I consider myself as a strong learner in the medical field. I also do have some strengths and some weakness. My academic and healthcare backgrounds are helping me a lot in all learning experiences.

My Strength:  

·        Active listening skills. I do believe in listen and learn strategy.
·        Organization skills. I love to study in an organized way. I like to make a routine first and try to follow the routine.
·        I love problem solving, which will definitely help me in the future.
·        I always try to meet all the deadlines.
·        I welcome the feedback from my instructors and peers.


My areas of growth

•  I need to work on my logical argumentative skills. 
•  Sometimes it is hard for me to think "outside of the box”. I need to connect my thinking ability to learning ability
•  Procrastination. I need to work on this thing as early as possible.

  

Learning Style and Strategy:  I used two online assessment systems to determine my learning style. Those are:

Index of Learning Styles Questionnaire by Barbara A. Soloman and Richard M. Felder

According to this assessment, I am mostly a reflective learner. I prefer to think about anything quietly first, then go through the whole thing, which suits me perfectly. I also like to study alone, which also defined me as a reflective learner. But I need to acquire some attributes of active learners. I shouldn't memorize and read all the time; I also need to make some summaries of the class notes which will help me before the exams.

Next, I am fairly well balanced between sensing and intuitive learners. But, I think that, I mostly belong to sensing learner type. I do have some attributes of intuitive learners as I sometimes prefer discovering possibilities but most of the time, I don’t like any complications in my life and also in my study. I also prefer to learn about new concepts like intuitive learners; on the other hand, I am more practical like sensing learners.

Thirdly, I am also well balanced between visual and verbal category. I am completely agreed with the assessment. However, I don’t like to use pictures or diagrams for better understanding or explanation.

Finally, the assessment defined me as a sequential learner. But I think I am also well balanced between these two characters. Sometimes I like to follow all the steps to study something, however sometimes I like to solve some complex subjects in an innovative way. I also like to skim through the whole chapter first before starts studying this subject which is an important character which can be define me as a global learner

The VARK Questionnaire

According to this assessment tool, I have a strong preference for learning by Reading and Writing. I know the reason behind it.

I completed my most of the studies in Bangladesh where the preferences are mostly given on reading and writing. So, I also like to learn by Write out the words again and again, read my notes silently, or by rewriting the ideas in my way. I also like to make my own invented mnemonics which helped me a lot in the past.

Next, the assessment also described me as a kinesthetic learner. This means, I like to use all my senses - sight, touch, taste, smell, hearing during my learning process. I did not know that before the assessment. But I am somehow able to define me as a kinesthetic learner. For example I always like to practice before the OSCE; I also like to do some practical exams rather than the typical written exams.

Learning Context: I am fairly new to the world of online learning. But so far, I think online learning is the future of the learning world. I am able to do all my household works, give some time to my wife and prepare all my assignments at the same time. This is almost impossible in the face to face learning. Online learning technology will grow day by day and some glitches of online learning will also be diminished in the future. I am always a reflective learner, so I am pretty much happy with the online learning.

Conclusion: As an emerging PA, I want to accomplish all my career goals as early as possible.I am becoming spiritual learner day by day, and I want to spend some of the valuable moments of the life to discover myself and to find out the meaning of the relationship between me and this beautiful world

Read more