Upon completion of this placement, the Physician Associate student will be able to obtain/utilise the appropriate database (history, physical exam, lab and x-ray studies) relative to geriatric patients with common acute and chronic illnesses. They will develop an understanding of geriatric medicine as a specific body of knowledge and will be aware of the health problems that are most commonly encountered in the elderly patient. Diagnostic skills will be fostered, alongside emphasising the balance of clinical management with physical, social, and financial costs.
In the context of an ageing population, Physician Associates are frequently being involved in care of the older person. Through this rotation, Physician Associate students will have an increased sensitivity to the aging process, with respect to the clinical aspects, cognitive function, social and psychological concerns of patients.
Objectives
History Taking and Consultation Skills
The student will be able to obtain a comprehensive medical history from a patient, relative, or other informed party. The student will demonstrate:
- Use of a problem-oriented approach to gathering subjective information.
- The ability to collect comprehensive details pertinent to the patient's problem(s), including:
- Presenting complaint
- History of presenting complaint
- Past medical history
- Family medical history
- Personal/social history
- Review of systems
- Collateral history
- Patient’s previous medical records
- Use of effective interview methods
- Evaluation of historical facts
- Demonstrate an appropriate examination in the elderly, including mental status testing and functional assessment.
- Explain the spectrum of altered presentation of disease in the aged, and the factors responsible for this alteration.
- Demonstrate appropriate communication and interpersonal skills when interacting with older patients and their families.
Physical Examination
The student will be able to perform appropriate physical examinations, demonstrating the ability to:
- Identify normal and abnormal physical findings.
- Perform proper examining techniques.
- Utilise physical examination findings to support or modify tentative diagnostic impressions developed from the patient’s history.
Clinical Judgment in Diagnosis and Management
- Order indicated laboratory tests
- Obtaining technically valid specimens
- Performing appropriate procedures
- Evaluate results of diagnostic tests to support or modify tentative diagnostic impressions
- Considering the therapeutic benefit of costly tests
- Develop a plan of investigation and be able to determine the appropriate laboratory, radiography, and/or other diagnostic studies and tests that are indicated
- Based on historical, physical, laboratory, and/or radiographic data, develop a differential diagnosis list, tentative clinical diagnosis, and/or problem list for physician consideration, review and comment.
- Apply understanding of rehabilitative therapy in managing patients with CVA’s, fractures, arthritic limitation, and amputations.
- Identify available social resources and community programs in planning the care of an elderly patient. Develop an understanding of the pressures experienced by caretakers of elderly patients.
Clinical Planning and Procedures
- Recognise indications for physician consultation.
- Formulate and assist in implementation of a management plan including:
- Medical therapies, procedures, and treatments.
- Patient education and counselling procedures.
- Preventive measures.
- Follow-up care.
- Realistic treatment goals.
- Develop skills necessary to perform or assist in the performance of common diagnostic and therapeutic procedures.
- Prescribing and Therapeutics
- Demonstrate awareness of common problems in pharmacotherapy including polypharmacy, adherence to medications, drug interactions, bioavailability, and side effects in older patients.
Physician Associate Role
Recognise the role of the Physician Associate in care of older patients, and the importance of developing effective interpersonal relationships with patients and professionals, including:
- Attaining interpersonal skills to facilitate the patient's understanding of their condition/s and cooperation with their therapy.
- Demonstration of concern for the patient, maintaining a professional attitude and respecting the patient's privacy.
- Communicating effectively with other members of the MDT
- Developing an understanding of the capabilities and limitations of the PA within the context of care of the elderly