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As our team started to set up clinic in a small church made out of clay, there was already a line of around 40 patients waiting to receive medical care and it was only 7:00AM. The clinic consisted of our traveling pharmacy, a “massage table” (just a hard fold up table), one triage station, and 4 “exam rooms” which simply consisted of two plastic chairs with no walls. This was the clinic that we set up on the first day of my medical mission trip to Honduras. The team at this site consisted of four DO students, two PA students, four pharmacy students, one practicing PA (Mr. Pin), and one practicing Honduran doctor. We worked efficiently as an inter-professional team to treat over 800 patients in one week. This trip truly embodied how an inter-professional team should work to benefit the patient. In addition, I was personally exposed to each profession which instilled a deeper understand of how each team member works for the benefit of the patient.
During the first day of the clinic, one DO student (Jessica) and one pharmacy student (Devin) triaged every single Honduran patient that came for care. This triage duo hardly knew how to speak Spanish. However, with a Spanish medical book in one hand and blood pressure cuff in the other, they successfully triaged all the Spanish speaking patients. They were able to obtain a chief complaint and vitals so the flow of the clinic could keep moving. Patients were then lined up to be seen by the “providers”: Maegan Hewett (now Coates), a Honduran doctor, one DO student, and myself. We stayed busy performing histories, physical exams, full assessments and diagnosing the patients. Maegan, the DO student, and I would present each patient’s case to Mr. Pin. He would then have us write the prescription and send the patient over to the pharmacy. In the pharmacy, three pharmD students were busy filling these prescriptions and writing instructions down in Spanish. Meanwhile, two DO’s students used the massage table to perform osteopathic muscle manipulations for treatment of patients with muscular-skeletal complaints. The day seemed to flow very smoothly and we worked together to treat over 100 patients in the first day. Some patients had never been seen by a doctor in their whole life; I believe this positively impacted the community we treated.
One specific example of how our inter-professional team effectively treated a patient is how our team cared for a middle-aged man who suffered from back pain. This patient went to the triage table where he talked to Devin and Jessica. Like every patient, his vitals were recorded and he was given a paper that the triage team helped to fill out, which listed his past medical history, family history, social history, allergies, and medications. This procedure significantly helped speed up the process in the clinic. When the patient completed triage he came to me. I got a more detailed history of present illness (HPI) from the patient, I listened to his heart and lungs, and then I was able to do a full MSK and neuro exam. After my examination of him, I presented this case to Mr. Pin and we sent this Honduran male to the DO’s. They did their own assessment and successfully performed a muscular manipulation that significantly improved his back pain. They also gave him home exercises to strengthen his back. Finally, he walked over to the pharmacy and was given NSAIDs to decrease the inflammation. This man was a melon farmer and spent long days picking melons and tilling the soil. His back had significantly suffered from his occupation. However, with the help not only from the pharmacy but also from the exercises and muscle treatment, this man received outstanding care that will help him continuously, long after our traveling clinic left.
The second day of the trip Mr. Pin decided to switch things up. He had more of the DO and pharmacy students work as the providers and he put me in the pharmacy. I felt completely out of my element; pharmacology was never my strong suit. One of the pharmacy students, Ryan would quiz me on hypertension drugs. With his help, I was able to fill prescriptions and become more familiar with them. I also realized that there is more to pharmacy than filling prescriptions. Ryan discussed different cross reactions with me and drug’s mechanisms of action. At one point we even had to crush an antibiotic and put it into a syrup form for a pediatric patient. This time spent in the pharmacy helped me understand and value the work that a pharmacist completes.
The rest of the week I was able to rotate jobs. One day I worked at the triage table, which helped to improve my Spanish skills and understand the difficulty of seeing every patient that walked through the door. My favorite day was when I got to work with a third year DO student, Jess. Jess taught me multiple muscle manipulations and even an osteopathic technique to help relieve constipation. This helped me to understand the DO profession and deepen my admiration for my colleagues. I also believe that this trip helped the students of other professions understand the role of a Physician Assistant. The first year DO students were surprised by how much we knew. Overall, everyone benefited from quality time spent in each healthcare profession.
The lessons that I learned on this trip were countless. But if I had to pick one lesson it would be: I need to respect and understand each team member’s role in patient care. In other clinical experiences, I have met some doctors that do not have respect for what the nurse’s role or a nursing aid’s role is in patient care. I believe that not only does the patient suffer in this scenario, but the team members suffer as well. My trip also taught me that without each team member the clinic would not run as well as it did and less patients would have been seen. Being a PA, I will be responsible for managing a team of inter-professional health care providers. If I do not have respect for what each profession does or what they contribute to the patient’s care, the team members will not effectively do their job. This in turn will negatively impact the patient. And of course, “it’s all about the patient.”
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In the ever-changing world of medicine, effective interprofessional interaction and coordination between the many member of the healthcare team is becoming even more crucial. This collaboration within patient care creates better efficiency, as well as creates a system of check and balances that helps to improve patient safety. Most importantly, with effective interprofessional interactions there are better overall long-term outcomes for patients. Hospitals and clinics are aiming towards a more toward patient-centered medical home structure, in large part due to the effectiveness of a role-based and team-oriented environment. Throughout my rotations, I have continually observed effective interprofessional interactions; in emergency departments, within the hospital, in specialty settings, and in small out-patient clinics. Observing these effective interactions, I have come to truly value the importance of interprofessional collaboration in the medial field. Particularly, in my in-patient psychiatry rotation in Lumberton, I not only observed effective interactions within the vast clinical team on the psychiatry floor, but felt I myself had effective collaborative interaction with the Campbell DO students also with me on the rotation.
In this rotation, I observed how in the in-patient psychiatry environment, it is so important that case workers, social workers, psychiatrists, PAs, nurse practitioners, and all nursing staff have clear and open communication with one another. Coordination of care of these patients is so important not only while these patients are hospitalized, but also when coordinating their discharge and out-patient treatment plan. One crucial aspect of this effective interprofessional team-based setup is that each morning every member of the team met for rounds and went through every single patient who was residing on the in-patient psychiatry floor. This way, every team member is on the same page as to why the patient was admitted, their diagnoses, and their mediations and changes made. Also important is that all staff are updated on how each team member had observed the patients and their interactions, which can be indispensable information when tailoring treatment plants. Every day during rounds, the team set realistic goals as to when they felt the patient would be safe for discharge from the unit.
Many of the psychiatric patients come from poor home living situations with little social support. They had not only multiple psychiatric comorbidities, but often have many other significant medical comorbidities. Therefore, in order to coordinate care in an appropriate manner it is really crucial to have clear communications on a patient’s medical status, current medications and changes of medications, and plan for outpatient disposition. These daily rounds provided this great synchronization of information for each patient on the floor. Every team member provided a different angle, as they each had unique interactions with the patients; whether during provider interviews or with nurses and aides.
Case workers and social workers also provided crucial updates as to conversations had with family and what the facility placement options were for patients whom would not be safe for self-care disposition. Some of these patients required services set up out-patient where medications and injections would be given to them by home visits to ensure compliance. I saw how valuable these team members are in this setting in improving long term outcomes, setting up outpatient psychiatric follow-up services, and hopefully decreasing rates of readmission.
Also from a personal standpoint on this rotation I was fortunate to work with three Campbell DO student during my four weeks there. Initially, as a group I think all four of us felt slightly overwhelmed in this new environment. We had a steady and diverse patient load and tasks to complete from day one, without much instruction. However, by getting to know each other quickly we worked together to develop ways to get our work done effectively and efficiently. This took teamwork as patients on the floor were often a complicated patient population. By working and sharing tips as a group, we truly improved in our patient care of this population.
Additionally, I valued studying with the medical students and I feel we could each share different information that we had each learned during our didactic learning. The DO students spend more of their learning of pathophysiology, while I feel in PA education we establish a strong practical pharmacology knowledge base. I think by combining our knowledge foundations, we were able to help one another in patient management. Additionally, we were able to communicate effectively and break up our tasks, as well as team-up on patient consults to get them done most efficiently completely. I was impressed at how we grew as team despite our differences, and I enjoyed the oppourtinity to work with other Campbell students.
In this psychiatry rotation that involved a patient population that I had little initial experience with, I feel fortunate that I was able to observe the value of team-based interprofessional patient management. I saw how imperative it is in the safety and long-term management of patients. Additionally, on this rotation I was able to myself get interprofessional experience, working with a team of Campbell DO students in which we shared our knowledge, worked together, and problem-solved as a group in a new and diverse setting.