Physician Assistant Profession Origins PDF

THE PHYSICIAN ASSISTANT PROFESSION The Origin of the Profession and Its Supporting Organizations Andrew W. Hull, DMSc, PA-C Program Director, Chair, and Associate Professor of PA Studies Milligan University PA Program  PA...

THE PHYSICIAN ASSISTANT PROFESSION The Origin of the Profession and Its Supporting Organizations Andrew W. Hull, DMSc, PA-C Program Director, Chair, and Associate Professor of PA Studies Milligan University PA Program  PA PROFESSION ORIGINS Feldshers in Russia Barefoot Doctors in China Military Corpsmen in the United States  FELDSHERS Originally German military medical assistants (field surgeon) Introduced into the Russian military system by Peter the Great in the 17 th century Large numbers of Russian troops relied on feldshers for a majority of their medical care due to a physician shortage Feldshers who retired from the military settled in small rural communities, where they continued to provide access to health care Feldshers assigned to Russian communities provided much of the health care in remote areas of Alaska during the 1800s  FELDSHERS In the late 19th century, formal schools were created for feldsher training By 1913, approximately 30,000 feldshers had been trained to provide medical care Feldsher training programs, which were located in the same institutions as nursing schools, required 2 years to complete Unlike some PAs in the U.S., Feldshers did not work alongside the physician in his or her daily activities to improve the physician's efficiency and effectiveness and to relieve him of routine, time-consuming tasks They were used as physician substitutes in rural settings, where those who were experienced could diagnose, prescribe and administer emergency treatment In urban settings, their role was linked to primary care in ambulances and triage settings, and they were more complementary rather than substitutional FELDSHER PERFORMING AN AMPUTATION, 1540  Feldshers, used by Peter the Great’s army, continue to be educated and used in Russia. “The Soviet Feldsher as a Physician’s Assistant” was published by the National Institutes of Health, Bethesda MD, 1972.  BAREFOOT DOCTORS IN CHINA Originated in the 1965 Cultural Revolution as a physician substitute Known as the “June 26th Directive,” Chairman Mao (former chairman of the Communist Party of China) called for a reorganization of the health care system In response to Mao's directive, China trained 1.3 million barefoot doctors over the subsequent 10 years  BAREFOOT DOCTORS IN CHINA Received their initial 2- to 3-month training course in regional hospitals and health centers Designed to function independently, but barefoot doctors were closely linked to local hospitals for training and medical supervision They were encouraged to continue their training, and they were given priority for admission to medical school In the early 1980’s, the use of feldshers and barefoot doctors was significantly greater in their respective countries than the use of PAs in the U.S. Now, the numbers of both feldshers and barefoot doctors have declined in their respective countries owing to a lack of governmental support and an increase in the numbers of physicians The number of PAs has dramatically increased in the U.S., especially over the last decade  The bottom photograph is from the official promotion of the barefoot doctor program in the early 1970s when Mao Zedong called for the training and deployment of Barefoot doctors to rural areas of China DEVELOPMENT OF PHYSICIAN ASSISTANTS IN THE UNITED STATES Starting in the 1930s, former military corpsmen received on-the-job training from the Federal Prison System to extend the services of prison physicians In 1961, Charles Hudson, MD, proposed the concept at an American Medical Association (AMA) conference and recommended that “assistants to doctors” should work as dependent practitioners, performing tasks such as suturing, lumbar punctures, and intubation Numerous physicians in private practice started using informally trained individuals to extend their services around this time Dr. Amos Johnson and Mr. Buddy Treadwell DEVELOPMENT OF PHYSICIAN ASSISTANTS IN THE UNITED STATES In the late 1950s and early 1960s, Eugene Stead, MD, developed a program to extend nurse capabilities at Duke University hospitals Could have initiated the nurse practitioner movement Opposed by the National League of Nursing because this type of program would move these new providers from the ranks of nursing to the “medical model” The Duke program and other new PA programs arose at a time of national awareness of a health care crisis DEVELOPMENT OF PHYSICIAN ASSISTANTS IN THE UNITED STATES The first 4 students started the Duke PA program in October of 1965 All 4 students were ex-Navy corpsmen The 2-year training program's philosophy was to provide students with an education and orientation similar to those given the physicians with whom they would work The “medical model” The program originally called for 2 categories of PAs, one for general practice and one for specialized inpatient care It was decided to focus on primary care The program also emphasized the development of lifelong learning skills to facilitate the ongoing professional growth of these new providers Three students completed the program.  CHALLENGES OF EDUCATION AND PRACTICE The concept of medical education was first to learn basic sciences, then to learn normal structure and function, and finally to learn pathophysiology This was completely different with PA education as some of the early PAs had no formal college education Prior to the PA profession, the physician was the sole possessor of information, and neither patient nor other groups could penetrate this wall The developing PA profession was the first to officially share the knowledge base that was formerly the “exclusive property” of physicians The “primary care” nature of PA training made the PA very adaptable to almost any patient care setting This was good and bad in that PAs who were trained in primary care could easily adapt to specialty areas, but it was not the original intent for PAs to practice in specialty areas  MILITARY CORPSMEN The choice to train military corpsmen as the first PAs was a key factor in the success of the concept This made the PA concept one of the few “positive products” of the Vietnam War This also capitalized on the previous investment of the U.S. military in providing extensive medical training to these men  NAME CONTROVERSY In 1970, the American Medical Association (AMA)-sponsored Congress on Health Manpower chose the term associate rather than assistant because they felt as though this signified a more collegial relationship between the PA and supervising physicians Despite this, the AMA’s House of Delegates rejected the term associate, stating that it should only be applied to physicians working with other physicians Some programs continued using the term associate, and this debate has resurfaced recently as the AAPA has changed its name from assistant to associate Numerous programs now use the term “physician associate program” and numerous states use physician associate Many people are continuing to advocate for a name change for the entire profession  NAME CONTROVERSY There has been an apostrophe used in the name in the past, and some people still use the apostrophe in the name This implies ownership by one physician (physician’s assistant) or multiple physicians (physicians’ assistant) DO NOT USE THE APOSTROPHE, either in how the name is written or pronounced The correct term is Physician Assistant!  PROGRAM EXPANSION 31 new PA programs were established between 1971 and 1973 This was due to available federal funding By 1975 (10 years after the start of Duke’s first PA program), there were 1,282 graduates of PA programs 9 new programs were added between 1974 and 1985 The AAPA estimated that there were 16,000 practicing PAs in the U.S. in 1985 76 programs were accredited between 1965 and 1985, but 25 of those programs closed for various reasons  PROGRAM EXPANSION In 2011, there were 159 accredited PA programs As of December 2024, there were 311 accredited PA programs There were approximately 80,019 certified PAs at the end of 2010 The profession has grown 75.2% over the past 10 years, reaching 178,708 certified PAs at the end of 2023 There are 52 applicant programs listed on the ARC-PA’s website as of January 1, 2025 that are developing PA programs.  NEED FOR PHYSICIAN ASSISTANTS Projected physician shortage of between 13,500 and 86,000 physicians by 2036 Projected shortfalls in primary care range between 20,200 and 40,400 physicians by 2036 Projected shortfalls in non-primary care specialties range between 19,500 to a surplus of 4,300 by 2036 Projected shortfall in surgical specialties is between 10,100 and 19,900 surgeons by 2036  NEED FOR PHYSICIAN ASSISTANTS What is causing the physician shortage? Population growth and aging Physician retirement Achieving population health goals  ACCREDITATION Accreditation of formal PA programs became imperative because the term physician assistant was being used to label a wide variety of formally and informally trained health personnel The AMA (working together with the National Academy of Health Science’s Board of Medicine, American Academy of Pediatrics, American Society of Internal Medicine, American Academy of Family Physicians, and the American College of Physicians) approved the creation of “educational essentials” for the accreditation of PA training programs in 1971. Started processing accreditation applications and conducting site visits for programs in 1972  CERTIFICATION The first certifying examination was administered by the National Board of Medical Examiners (NBME) to 880 candidates at 38 locations in December 1973 This was the first time that the NBME had engaged in examining any health professional other than physicians The cooperation of the AMA and the NBME ultimately resulted in the creation of the National Commission on Certification of Physician Assistants (NCCPA) in August 1974 The NBME would continue to develop and administer a certifying examination, but the NCCPA would assume the responsibility for the requirements for eligibility, the setting of a passing standard, and other conditions for initial certification and periodic recertification The NCCPA would issue certificates and become the conduit to state regulatory agencies  CERTIFICATION Since 1986, only graduates of formally accredited PA programs have been eligible for the NCCPA examination The first recertification examination was given in 1981  SUPPORTING ORGANIZATIONS American Academy of Physician Assistants (AAPA) Physician Assistant Education Association (PAEA) State PA Organizations such as the TN Academy of PAs (TAPA) Specialty Organizations Example: Society of Dermatology PAs (SDPA)  AAPA Began in 1968 as the American Association of Physician Assistants Headquartered in Alexandria, VA Multiple other organizations were also established around this time with the goal of speaking for the new profession, but ultimately the American Academy of PAs was formed as the single voice of professional PAs First AAPA House of Delegates meeting was convened in 1977  AAPA Governed by a 13-member Board of Directors, including officers of the House of Delegates and a student representative Includes 10 standing committees and 4 councils There are specialty groups and formal caucuses that bring together academy members with a common concern or interest The AAPA's Student Academy is composed of chartered student societies from each PA training program The annual conference serves as the major political and continuing medical education activity for PAs, with an average annual attendance of 7,000 to 9,000 participants  AAPA Capital Connections – scheduled in March of each year Staff of AAPA  PAEA Began as the Association of Physician Assistant Programs in 1972 Started as a network in which programs could work on curriculum development, program evaluation, and the establishment of continuing education programs Helped to define the role of the physician assistant The Association of Physician Assistant Programs (now the Physician Assistant Education Association, PAEA), like the Association of American Medical Colleges (AAMC) represents educational programs, whereas the American Medical Association and the American Academy of Physician Assistants represent individual practitioners.  PAEA APAP became PAEA in 2004 It is governed by a twelve-member Board of Directors, including a student representative Ten standing committees and two institutes do the work of the organization, as well as special committees and task forces, which are assigned to deal with specific concerns or emerging issues PAEA began a nationwide centralized electronic application process (CASPA) in 2001 to streamline PA program application They produce a formal publication, The Journal of Physician Assistant Education, and provide many CME and professional development opportunities Annual PAEA Forum held in October of each year THE POLITICAL PROCESS Andrew W. Hull, DMSc, PA-C Program Director, Chair, and Associate Professor of PA Studies Milligan University PA Program  THE POLITICAL PROCESS You are a PA living in a state that does not have prescriptive privileges for controlled medications for PAs. You have been asked by the state chapter to become politically active on behalf of your profession to improve health care in the state. What do you do? HOW A BILL BECOMES A LAW  INDIVIDUAL RESPONSIBILITIES IN THE POLITICAL PROCESS Understand the political process and use that knowledge to advance the interests of patients Stay up-to-date on current issues and trends in health care by reading journals, newspapers, and professional publications Vote Maintain contact with your elected representatives (personal meeting, email, phone call, or letter) Help with campaigns Support your national and state PA organizations  PRACTICE LAWS Occupational regulation is the responsibility of the state, not the federal government Every state licenses, certifies, or registers a number of different professions and occupations, from architects and barbers to physicians and plumbers Occupational regulation has one main goal: public health and safety This protection is given by granting licenses only to individuals: Who meet minimum standards of education and skill Who abide by their defined scope of practice Who understand they will be disciplined if they break the law or fail to uphold certain professional standards  PRACTICE LAWS PAs belong to a regulated profession An individual seeking to work as a PA must first obtain permission from the state and then abide by any conditions of practice that the state has established This is called licensure There is growing uniformity in state laws that govern PAs This is thanks to the efforts of AAPA and state PA organizations Total uniformity is unrealistic and should never be expected because each state writes and interprets things differently than others Board of Physician Assistants regulates PA practice in TN and in most states This board was transitioned from a committee of PAs that worked with the Board of Medical Examiners to an independent board in 2021  PRACTICE LAWS The two universal requirements for obtaining state credentials (best referred to as “licensure”) as a PA are: Graduation from an accredited PA educational program Passage of the Physician Assistant National Certifying Examination (PANCE), administered by the National Commission on Certification of Physician Assistants (NCCPA)  PA LAWS AND REGULATIONS State license must be renewed on a regular cycle, every 1, 2, or 3 years depending on the state (every 2 years in TN) PA laws and regulations also include criteria for physician supervision Laws or regulations may place restrictions on which kinds of medications a PA may prescribe A good state law is one that allows physicians to delegate to PAs any task or responsibility within their scope of practice that the PA is competent to perform Scope of practice of PAs can be limited by a law, a regulation, or even a licensure application that contains a list of tasks that physicians may delegate  THE SIX KEY ELEMENTS OF A MODERN PA PRACTICE ACT* “LICENSURE” AS THE REGULATORY TERM FULL PRESCRIPTIVE AUTHORITY SCOPE OF PRACTICE DETERMINED AT THE PRACTICE LEVEL ADAPTABLE COLLABORATION (or PROXIMITY) REQUIREMENTS COSIGNATURE REQUIREMENTS DETERMINED AT THE PRACTICE LEVEL NUMBER OF PAS A PHYSICIAN MAY COLLABORATE WITH DETERMINED AT THE PRACTICE LEVEL (Physician may practice with unlimited number of PAs) *Source: https://www.aapa.org/download/65127/ Updated 10/2024  AAPA ROLES Advocacy and government relations Research and data collection Public education Publications Continuing medical education and professional development Employment Other member services  AAPA ADVOCACY AND GOVERNMENT RELATIONS Speak for the profession before the U.S. Congress and federal agencies It is difficult for one individual to affect the shape of laws and regulations Legislators are more responsive to organizations that convey the interests of a large group than they are to individuals The Academy voices the PA profession's views on federal legislation and regulations  AAPA ADVOCACY AND GOVERNMENT RELATIONS Lobbying is done by the professional staff of the AAPA Lobbying is seeking to influence (a politician or public official) on an issue Legislative alerts and Academy publications are used to inform AAPA members about important issues or to request that they contact their congressional representatives or a federal agency about a particular subject They invite members to attend a government affairs conference in Washington that includes a day on Capitol Hill – this is done twice/year  STATE PA ASSOCIATIONS Chartered constituent chapters of AAPA State associations employ professional association management staff, and many have lobbyists and legal counsel Most substantive work is done by the members themselves  HOW A BILL BECOMES A LAW Legislative proposals may be introduced by senators or representatives when Congress is in session The bill is prefixed with HR when introduced in the House of Representatives and S when introduced in the Senate It is given a number and referred to the committee that has jurisdiction over the bill’s subject matter A bill receives its sharpest scrutiny in the committee  HOW A BILL BECOMES A LAW If a committee decides to act on a bill, it conducts hearings to provide the executive branch, interested groups, and individuals opportunities to formally give their views on the issue After hearings conclude, the committee meets to “mark-up” the bill and decide on the language of amendments When a committee votes to approve a measure and send it to the floor, it sends a report with the bill that justifies its actions This report is very helpful because it describes the purpose and scope of the bill, explains the committee amendments, indicates proposed changes in existing law, and frequently includes instructions to government agencies on how the language of the new law should be interpreted and implemented  HOW A BILL BECOMES A LAW Most bills never make it out of committee This is due, in part, to the enormous number of bills brought to committee each 2- year Congress (approximately 25,000 bills) Many bills are repetitive Many lack sufficient support Many are ignored on purpose in order to “kill” them Only a small percentage of bills that are introduced become enacted into law  HOW A BILLS BECOMES A LAW In the House of Representatives, the Rules Committee sets the guidelines for the length and form of the debate that takes place The Senate, on the other hand, calls up a bill by voting on a motion to consider it or by “unanimous consent,” in which the bill comes up for a vote if no one objects Bills may be further amended on the floor before a vote in both the Senate and House of Representatives When a bill has been passed, it is sent to the other chamber for action, and the entire process starts over Usually, the other chamber will make changes, and unless the chamber that first passed the bill agrees to these changes, a House-Senate conference is arranged to resolve the differences  HOW A BILL BECOMES A LAW When approved by both chambers of Congress, a bill is sent to the White House If the president favors the bill, he may sign it into law If the president opposes the bill, he may veto the law in which case it is returned to Congress Congress may override the veto by getting a two-thirds vote in the House and the Senate  STATE LEGISLATIVE PROCESS Sometimes it is necessary for your state PA chapter to work closely with legislative staff in the initial phase of writing a bill in order to get what you need The second step is finding someone to sponsor the bill The bill is then printed and introduced by reading it to the entire chamber in which it is introduced In most states, there is a gatekeeper committee (usually the rules or finance committee), and once a bill is introduced it is referred to this committee This is where it helps to know someone on the gatekeeper committee This is also where your state chapter can be very helpful  STATE LEGISLATIVE PROCESS Once a committee approves a bill, it goes to the full chamber for a vote Continue to maintain contact with the appropriate people prior to the vote For the most part, the full House follows a committee's recommendation on a particular bill That is why working with the committee is so important! A bill that passes the first chamber must then be introduced in the second. Everything you did in the first chamber must be repeated: visits, thank you notes, committee meetings, more visits, etc. Once a bill has passed both chambers, it must be signed by the governor before it becomes effective The governor may veto the bill, and a 2/3 vote can override the veto  STATE LEGISLATIVE PROCESS Legislators look to stakeholder groups to help them develop their response to legislation STAKEHOLDERS TO WORK WITH BEFORE DRAFTING LEGISLATION State medical society State association of family physicians State association of emergency physicians Rural health association Primary care association Hospital association Other organizations with a particular interest in the topic of your legislation  FEDERAL AND STATE REGULATORY PROCESS Once a law has been passed, an agency (or agencies) is charged with developing the regulations necessary for its implementation The staff of a bill's sponsor can tell you who is going to be writing the regulations This is another time to get involved! It is much easier to influence what gets written than it is to change what has been written PROCEDURES FOR STATE RULE MAKING  THE POLITICAL PROCESS You are a PA living in a state that does not have prescriptive privileges for controlled medications for PAs. You have been asked by the state chapter to become politically active on behalf of your profession to improve health care in the state. What do you do?  SUMMARY You do not need a huge number of people or a large war chest to win a legislative battle. You need to mobilize the membership. Membership input is crucial. If you choose to be a chapter leader, give the membership the information they need to write an intelligent letter. If you choose not to be a chapter leader, write intelligent letters when asked. You do not have to be a professional lobbyist to win. Professional lobbyists are great—they know the system and when to pull which strings—but you can do much of what they do. Legislators want honest information. Deliver it with enthusiasm, and you are halfway home. Look for windows of opportunity in both timing and alliances. Sometimes the best strategy is to wait until a powerful opposing force is moved out of the way by an election or expiration of a term of office.  SUMMARY There is no need to “go it alone.” Work closely with the AAPA and/or TAPA. Alliances with physician organizations can be extremely helpful in making both legislative and regulatory changes. You must be persistent. Do not be discouraged if your efforts require multiple legislative sessions to complete. Keep at it. The most important lesson: Keep patients first. When you focus your advocacy message on how it will have a positive impact on patient care, you will keep a firm foundation.  PATIENT SAFETY Andrew W. Hull, DMSc, PA-C Program Director, Chair, and Associate Professor of PA Studies Milligan University PA Program  PATIENT SAFETY http://www.medscape.com/viewarticle/863788  PATIENT SAFETY In 1999, the Institute of Medicine (IOM) Committee on the Quality of Health Care in America published a landmark report entitled, To Err Is Human, Building a Safer Health System. The report cited a study that estimated 98,000 people died every year in U.S. hospitals as a result of medical errors. This is equivalent to crashing a jumbo jet every day for a year and killing all the passengers on board According to the Medscape article, the number of deaths from medical error is now over 250,000/year and ranks as the third leading cause of death behind only heart disease and cancer  PATIENT SAFETY Medical errors have been hidden from the public in the past The IOM reports that “The biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures, but as opportunities to improve.” The “blame and shame” approach to medical errors has now been replaced with a systems approach such as that seen in airlines, nuclear power plants, and other high-risk occupations  PATIENT SAFETY The Swiss cheese model of organizational accidents developed by British psychologist James Reason is a good way to illustrate how medical errors occur (Figure 40-1). Rather than errors being the result of a single incident, they are viewed as multiple layers of fail-safes in which the holes align to produce a medical error SWISS CHEESE MODEL  PATIENT SAFETY The overwhelming majority of medical mistakes are not made due to lack of knowledge, training, or information They are made by honest, hard-working individuals who have demanding and often stressful jobs They often occur during automatic tasks as unintentional performance lapses in an environment where faulty processes, systems, or conditions fail to catch or prevent the error The medical profession is often compared with other high-risk occupations whose members must perform under a high degree of stress with a high degree of accuracy The difference is that medical professionals must combine complex decision-making with customer interactions and automatic behaviors  PATIENT SAFETY The Joint Commission defines a sentinel event as a patient safety event (not primarily related to the natural course of the patient’s illness or underlying condition) that reaches a patient and results in: Death Permanent harm (regardless of severity of harm) Severe harm (regardless of duration of harm) There are other specific qualifications related to sentinel events given in their report  PATIENT SAFETY Types of Sentinel Events: Infant abduction or discharge to the wrong family Unexpected death of a full-term infant Severe neonatal jaundice (bilirubin >30 mg/dL) Surgery on the wrong individual or wrong body part Surgical instrument or object left in a patient after surgery or another procedure Rape in a continuous care setting Suicide in a continuous care setting, or within 72 hours of discharge Hemolytic transfusion reaction due to blood group incompatibilities Radiation therapy to the wrong body region or 25% above the planned dose  PATIENT SAFETY The Joint Commission's top 10 most frequently reported sentinel events in 2023 were as follows: Patient falls – 48% Wrong site surgery – 8% Unintended retention of foreign object – 8% Assault, rape, sexual assault, or homicide – 8% Delay in treatment – 6% Suicide – 5% Fire or burns – 4% Medication management (error) – 2% Perinatal event – 2% Self-harm – 2%  MEDICATION ERRORS Medication errors cause at least one death every day and injure approximately 1.3 million people annually in the United States Common errors related to medication include illegible prescriptions and orders EHR has helped to reduce some of these errors  PREVENTION OF MEDICATION ERRORS Recognize common mistakes and take steps to prevent them from happening Pharmaceutical companies to stop creating drugs with similar names, or limit the number of drugs that look and/or sound alike Ban on the use of certain words or abbreviations when ordering medications See the “do not use” list that was developed by the Joint Commission in 2004  SURGICAL ERRORS Two of the top 10 sentinel events reported by the Joint Commission in 2023 were surgical events: Wrong-site surgery Unintended retention of foreign object To address surgical errors, the Joint Commission developed a universal protocol for preventing wrong-site, wrong-procedure, and wrong-person surgery (See Box 39.4 on page 490) The protocol mandates active involvement and effective communication among all members of the surgical team It involves a pre-operative verification process, marking of the surgical site, and a time-out procedure  TRANSITION AND COMMUNICATION ERRORS Lack of continuity of care is a huge problem in health care systems Patients do not really understand the value of establishing a relationship with one provider who knows and understands their medical history By seeing multiple providers, a patient will often have unnecessary office visits or duplicate lab tests or imaging studies Emergency Rooms, Urgent Cares, and even offices with a large number of providers contribute to this problem All of that being said, no one can provide around-the-clock care for their patients, so patients are inevitably cared for by multiple providers.  TRANSITION AND COMMUNICATION ERRORS Discontinuity provides an opportunity for the inaccurate transfer of data and thus, obviously, increases the risk of medical errors The Joint Commission reports that up to 80% of serious medical errors occur as a result of miscommunication between providers during transitions of care The Joint Commission has established a standardized approach to handing off patients that includes: Interactive Communication Up-to-date and accurate information Limited interruptions/distractions A process for verification An opportunity to review any relevant historical data  TRANSITION AND COMMUNICATION ERRORS There are multiple different sign-out protocols and communication tools that have been adapted from Formula 1 auto racing, aviation teams, and the U.S. Navy (communication on nuclear submarines) ANTICipate SBAR Traditionally, medical teams have had steep authority gradients that have discouraged communication by members of the team The patient safety movement has focused on teamwork and the leveling of responsibility to make all team members equally responsible for patient safety COMMUNICATE!  HEALTH INFORMATION TECHNOLOGY EMR can help to reduce medical errors Electronic prescriptions to reduce medication errors Most programs have an interactions checker Theoretically, there should be better access to information, but everyone is on a different EMR system and none of them communicate Love/Hate relationship with EMR  ROLE OF THE PATIENT Patients should play an active role in their own care They should know their medical history They should know their current medicines and allergies (bring a list or the actual prescription bottles/tubes if they cannot remember the names) Unfortunately, many patients have a hard time even doing these simple tasks, and it can make your ability to make the best decision/provide the best treatment option much more difficult Case Study  ROLE OF THE PATIENT Rights and responsibilities of patients as defined by the American College of Physicians: At the Appointment: Rights: To be an active participant in discussions To have understandable, legible instructions and prescriptions To have an explanation of why a particular course of treatment is recommended Responsibilities: To be open and honest about symptoms, drugs he or she might be taking, medical history To voice concerns To speak up if he or she does not understand To check back on test results  ROLE OF THE PATIENT At the Pharmacy: Rights: To receive the correct prescription To receive verbal and written information about how to use the drug To have information on drug interactions, side effects, and what to do about them Responsibilities: To check the prescription to make sure it is what the doctor ordered To remind pharmacists about other drugs or allergies To ask questions if necessary  ROLE OF THE PATIENT At Home Right: To research his or her condition using the library, Internet tools, etc. Responsibilities: To know the validity of the source of health information To verify health information with the physician  MEDICAL ERROR DISCLOSURE Three-step Disclosure Process: Step 1—Initial disclosure is all about empathy and reestablishing trust and communication with patients and families in the immediate aftermath of an adverse event. Providers say “sorry,” but no fault is admitted or assigned. Providers take care of the immediate needs of the patient/family (food, lodging, counseling, etc.) and promise a swift and thorough investigation. The goal is to make sure the patient/family never feels abandoned. In the spirit of good customer service, pull the patient or family closer to the providers and institution.  MEDICAL ERROR DISCLOSURE Step 2—Investigation is about learning the truth. Was the standard of care breached or not? We recommend involving outside experts and moving swiftly so that the patient/family does not suspect a cover-up. Stay in close contact with the patient/family throughout the process. Step 3—Resolution is about sharing the results of the investigation with the patient/family, as well as their legal counsel. If there was a mistake, apologize, admit fault, explain what happened and how it will be prevented in the future, and discuss fair, upfront compensation for the injury or death. If there was no mistake, continue to empathize (“we are sorry this happened”), share the results of investigation (hand over charts and records to patient/family and their legal counsel), and prove your innocence. However, no settlement will be offered and any lawsuit will be contested. Sorry Works! is compassion with a backbone.  REFERENCES Ballweg R, Brown D, Vetrosky DT, Ritsema TS. Physician Assistant: A Guide to Clinical Practice. Philadelphia, PA: Elsevier, Inc.; 2018 CrashCourse. How a Bill Becomes a Law: Crash Course Government and Politics #9.; 2015. Available at https://www.youtube.com/watch?v=66f4-NKEYz4. Accessed January 8, 2018. Tulane Center for Advanced Medical Simulation and Team Training. Patient Stories: Near Fatal A Patient Safety Story.; 2017. Available at https://www.youtube.com/watch?v=KymWoYBD53M. Accessed January 8, 2018.