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Professional Practice Resource Center

Patient-Provider Relationship

Provider Mental Health Concerns

 

OVERVIEW

The nccPA Health Foundation believes professional practice is integral to the provision of high-quality, accessible, and equitable health care. While some ethical dilemmas are common or recurrent,  others emerge in response to new science and technology, changing health care delivery, and current events. This Resource Center is intended to heighten awareness and foster dialogue. This center is being launched around two key professional practice priorities 1. patient-provider relationships and 2. substance-related issues with expansion planned to include additional practice-related topics. Want to suggest a topic or resource? Email us at contactus@nccpahealthfoundation.net.

Disclaimer:  The information on this site is not intended to be a substitute for professional advice. Information and references presented here are intended solely for the general information and education of the reader and inclusion should be interpreted as an endorsement.

Developing and nurturing one’s commitment to professionalism is an essential ingredient for high quality care, a finding amplified with a few data points:

  • Adopted by the PA profession’s national organizations, the Competencies for the PA Profession  describe seven competency domains that capture the breadth and complexity of modern PA practice, including professionalism and ethics. Within this (and each) domain, the PA profession has identified specific knowledge, skills, and attitudes that PAs in all clinical specialties and settings in the United States should be able to demonstrate throughout their careers.  The competencies serve as an important roadmap to guide individual PAs and others in promoting the development and maintenance of their professional competencies.

  • Similarly, as published by the New England Journal of Medicine, the Accreditation Council for Graduate Medical Education (ACGME) endorsed a set of competencies, including professionalism, to help define the foundational skills every practicing physician should address.  By extension, PA practice should embrace these competencies.

  • The principles of ethical practice are firmly embedded in PA educational curricula as required by the ARC-PA’s Accreditation Standards for Physician Assistant Education, 5th Edition and more information about how PA programs implement professional practice coursework is tracked in PAEA’s curriculum survey reports.   Finally, the Physician Assistant National Certifying Examination content blueprint notes that questions related to professional practice comprise 5% of the exam. 

  • NCCPA has adopted its Code of Conduct for Certified and Certifying PAs and PAs with the PA-C Emeritus Designation, and AAPA has adopted its Guidelines for Ethical Conduct for the PA Profession, underscoring the importance of professional, ethical practice throughout PA careers. 

  • When a provider’s commitment to professional, ethical practice falters, there may be consequences.  For example, data from the National Practitioner Databank illustrates that over the last ten years, nearly three percent of PAs have had professional practice issues that were reported. Consistent with the nccPA Health Foundation’s  mission to equip certified PAs to improve health, this Resource Center can serve as a source of valuable information and reminders to all PAs, of the importance of high standards in professional practice.  

 


The ideal models for the relationship between health care providers and patients are shifting.  While these relationships should be built on mutual trust and the principle of “do no harm,” it can sometimes be unclear how to effectively navigate these relationships while also integrating the patient’s values, goals, and decisions.  Within this domain, PAs and other providers may consider not only unprofessional behavior and boundary issues but also look more broadly at communication, patient experience, diversity and implicit bias, and burnout. 

Patient-Centered Care/Communication

Quality, patient-centered care relies on effectively communicating with patients (and caregivers) to ensure the patient’s voice is heard and shared decision-making is possible.

Journal article:  Lessons Learned from a Systems Approach to Engaging Patients and Families in Patient Safety Transformation. The Joint Commission Journal on Quality and Patient Safety. 2020. (LINK)

Toolkits & Guides:  Better Together: Partnering with Families: Changing the Concept of “From Families as Visitors” to “Families as Partners." Institute for Patient and Family-Centered Care. 2020. (LINK)

Toolkits & Guides:  The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families. Agency for Healthcare Research and Quality. 2020. (LINK)

Toolkits & Guides:  Partnering with Patients and Families to Enhance Safety and Quality: A Mini-Toolkit. Institute for Patient and Family-Centered Care. 2011. (LINK)

Journal article:  Communication Discrepancies Between Physicians and Hospitalized Patients. Archives Internal Medicine. 2010. (LINK)

Conference Proceedings:  Partnering with Patients and Families to Design a Patient and Family-Centered Health Care System: Conference Proceedings. Institute for Patient and Family-Centered Care. 2008. (LINK)

Journal article (subscription required):  Ethical Conflict in Nurse Practitioners and Physician Assistants in Managed Care. Nursing Research. 2006. (LINK)

Unprofessional Behavior 

Encouraging professionalism supports patient safety and satisfaction as well as more effective health care teams and systems. 

Journal article:  Treat rude behavior as a threat to patient safety. Journal of the American Academy of Physician Assistants. 2020. (LINK)

Journal article:  A practical framework for remediating unprofessional behavior and for developing professionalism competencies and a professional identity. Medical Teacher. 2019. (LINK)

Journal article:  Disrespectful Behavior in Health Care: Its Impact, Why It Arises and Persists, And How to Address It—Part 2. Pharmacy & Therapeutics. 2017. (LINK)

Journal article:  Unprofessional Behavior and Hospitalists. Journal of Hospital Medicine. 2012. (LINK)

Journal article:  A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety. The Joint Commission Journal on Quality and Patient Safety. 2008. (LINK)

Patient Experience 

Patients remember their health care experiences and striving to foster a positive experience contributes to patient satisfaction and treatment compliance. 

Journal article:  Patient satisfaction with physician assistant/associate care: an international scoping review. Human Resources for Health. 2019. (LINK)

Journal article:  Midlevel Providers in Orthopaedic Surgery: The Patient's Perspective. Iowa Orthopedic Journal. 2019. (LINK)

Journal article:  A framework for conceptualizing how narratives from health-care consumers might improve or impede the use of information about provider quality. Patient Experience Journal. 2018. (LINK)

Journal article (subscription required):  Evolving concepts of patient-centered care and the assessment of patient care experiences: Optimism and opposition. Journal of Health Policy Law. 2016. (LINK

Journal article:  Should health care providers be accountable for patients' care experiences? Journal of General Internal Medicine. 2015. (LINK)

Addressing Diversity 

One important aspect of patient-provider relationship is diversity, and these organizations provide additional information and resources to support diversity, equity, and inclusion. 

 

Additional Resources 

Web article:  Legal & Ethical Issues that Health Care Professionals Face. CHRON. 2018. (LINK)

Code of Medical Ethics:  Patient-physician relationships. American Medical Association. (LINK)

Center for Health Ethics:  Provider-Patient Relationship. University of Missouri School of Medicine. (LINK

CME Activity (subscription required):  Patient Rights And Ethics. StatPearls. 2021. (LINK)​

There are an increasing array of professional and ethical issues surrounding the use and abuse of legal and illegal substances.  PAs and other providers have an obligation to not only be responsible in their prescribing practices but also to guard against the potential for substance misuse and addiction among patients, colleagues, and even themselves.  Within this domain, PAs and other providers may consider a host of topics including responsible prescribing practices, diversion, provider substance use, and provider addiction. 

Burnout

Clinician burnout has profound effects on provider well-being and impacts the effectiveness and safety of patient care.

Webinar (CME):  Burnout Webinar Series. AAPA. 2022 (LINK)

Tookits & Guides:  PA Burnout. AAPA Career Central. 2022. (LINK)

Report: Addressing Health Worker Burnout: The US Surgeon General’s Advisory on Building a Thriving Health Workforce. Priorities of the US Surgeon General. 2022. (LINK)

Tookits & Guides:  Resource Compendium for Healthcare Worker Well-being. National Academy of Medicine. 2022. (LINK)

Journal Article:  Call to Action, Multidimensional PA Well-Being Strategies. Physician Assistant Clinics. 2021. (LINK)

Journal Article:  Depression, burnout, and professional outcomes among PAs. JAAPA. 2021. (LINK)

Journal Article:  Reasons PAs leave their jobs. JAAPA. 2021. (LINK)

Journal article (Subscription required):  Addressing PA Burnout. JAAPA. 2020. (LINK)

Journal article:  Burnout, job satisfaction, and stress levels of PAs.  JAAPA. 2018. (LINK

Journal article:  Burnout and Job and Career Satisfaction in the Physician Assistant Profession:  A Review of the Literature. National Academy of Medicine:  Perspectives – Expert Voices in Health and Health Care. 2018. (LINK)

Provider Substance Use and Addiction

Provider substance use and addiction may reduce productivity, contribute to errors, and put patient safety in jeopardy.  Clinicians should strive to be physically and mentally healthy.

Web article:  For Health Workers Struggling With Addiction, Why Are Treatment Options Limited? NPR. 2019. (LINK)

Journal article:  Prognosis for Emergency Physician with Substance Abuse Recovery: 5-year Outcome Study. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. 2014. (LINK)

Journal article:  Beyond Substance Abuse: Stress, Burnout, and Depression as Causes of Physician Impairment and Disruptive Behavior. Journal of the American College of Radiology. 2009. (LINK)

Journal article:  Successful Treatment of Physicians With Addictions. Psychiatric Times. 2009. (LINK)

Journal article:  Evaluating and Treating Disabled or Impaired Colleagues. Journal of Psychiatric Practice. 2007. (LINK)

Journal article:  Physician health programs and the potentially impaired physician with a SUD. Alcohol & Drug Abuse. 2006. (LINK

Journal article:  Identifying an Impaired Physician. Virtual Mentor. 2003. (LINK

Journal article:  Impaired Physicians: Is There a Duty to Report to State Licensing Boards? Harvard Review of Psychiatry. 2000. (LINK)

Organization:  International Doctors in Alcoholics Anonymous (IDAA) (LINK)

Organization:  Drug Enforcement Administration Diversion Control Division: Drug Addiction in Health Care Professionals. US Department of Justice. (LINK)

Responsible Prescribing Practices

Even with the legal authority to prescribe, PAs and other providers must follow ethical guidelines to ensure patient are safeguarded from harm and receive the best care. 

Journal article:  The APRN’s Role and Responsibility in Ethical Prescribing. Duquesne University School of Nursing. 2020. (LINK)

Web article:  How PAs Can Stay Out of Hot Water. Medpage Today. 2017. (LINK)