Physician assistants (PAs) “diagnose illnesses, develop and manage treatment plans, and often serve as a patient’s principle healthcare provider” (AAPA). This close relationship with patients necessitates a strong dedication to ethical adherence to provide optimal patient outcomes.

I had several motivating factors in deciding to pursue this career. Since early childhood, I have always taken a particular interest in medicine; there was something fascinating about knowing how our bodies work from the smallest organelles to complete body systems and learning how to remedy physiological dysfunctions. One motivator to become a PA was lateral mobility between specialties; I liked the idea of switching specialties rather than being stuck in one, like physicians. Finally, I chose PA because of the influence from my primary care providers. Initially, I was treated by a physician who did not want to spend time listening to me, making my experiences less than ideal. I switched to a PA in the practice and my whole experience flipped; she listened to and spent time with me. This patient-centered focus greatly influenced my decision to become a PA.

Good communication and proper treatment will be most important in my clinical practice. Good communication is crucial in healthcare; research shows that good communication improves patient experience and outcome (IHC). This includes listening to concerns, providing necessary information for decision-making, and properly educating and counseling patients (IHC). This is incredibly important in practice because it helps improve healthcare literacy since it ensures that patients will know about their conditions and treatment and fosters an environment of trust. Properly treating patients has two fronts: treating illnesses according to standards of care and treating patients respectfully and as people. These are fundamental in practice because they are part of the profession’s core values (AAPA 2013, 4). Treating patients properly medically is vital in establishing patient trust, helping patients achieve goals, and achieving the best possible outcome. On the personal level, treating patients properly facilitates trust and eases the burden of being sick by preserving sense of self.

The ethical principles that will be most applicable in good communication and proper treatment of patients medically and personally are beneficence, autonomy, and dignity. Beneficence is the obligation to purposefully do the most possible good, while minimizing harm, to help the patient achieve their goals (Yeo 2, 103). Autonomy is the ability to make decisions for oneself and is broken down into four components: free action (ability to accept or refuse treatment using one’s free will), effective deliberation, (process by which one makes a decision by logically weighing benefits and risks), authenticity, (alignment of one’s decision with their core values and beliefs), and moral reflection, (ability to discern how decisions will impact oneself and others) (Yeo 1, 92-95). Dignity is the reflection of a patient’s intrinsic and extrinsic value as a moral being deserving of respect (Royal College of Nursing, 8).

Beneficence supports good communication proper treatment. It supports good communication because communicating properly promotes the patient’s welfare and minimizes harm. For instance, thoroughly discussing diagnosis and possible treatments allows patients to fully understand their situation and make the best decision to align with their goals.  Additionally, properly communicating via listening to patient concerns supports beneficence because it allows the clinician to understand what their goals are, setting them on the correct course of action. From the medical treatment perspective, beneficence is guiding principle in treatment; for instance, injuries might be treated differently in an athlete versus a non-athlete because their values differ. From the personal perspective, beneficence is important because the patient’s values might misalign with the perceived proper treatment, but in treating the whole person, we must defer to beneficence.

Autonomy supports proper treatment medically and personally. It guides medical treatment because patients may accept and refuse treatments, regardless of possible benefit. Clinicians cannot force or withhold treatment if it violates autonomy. Thus, autonomy is extremely important for proper medical treatment. The same argument goes for proper treatment on the personal level; it is important to consider the patient’s autonomy during treatment because it helps preserve their sense of self. Violating autonomy can contribute to powerlessness for patients in situations where they already are out of control, as is the case with most illnesses.

Dignity relates to good communication and proper personal treatment. Good communication is rooted in dignity-preserving practices like speaking directly to the patient, using non-condescending tones, allotting sufficient time with the patient, listening to concerns, and making eye contact. Thus, dignity promotes good communication. Dignity supports proper personal treatment because it fosters respect for patients and self-worth. Being sick is demeaning in many ways since patients will be poked and prodded by many different people, but dignity-preserving practices like modesty, timely toileting, and providing interpreters results in improved patient experience, thus supporting proper personal treatment.

As I and look toward future practice, I hope to do right by my patients medically and ethically by employing the principles learned in this course.

 

 

Sources

 

Yeo, M et al. (2010). Autonomy [selections]. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 91-97, 103-109.

 

Yeo, Michael et al. (2010). Beneficence. In M Yeo et al. (eds.). Concepts and Cases in Nursing Ethics. [3rd edition] Ontario: Broadview Press, pp. 103-116.

 

Royal College of Nursing. (2008). Defending Dignity–Challenges and Opportunities for Nursing. London: Royal College of Nursing.

 

https://www.aapa.org/what-is-a-pa/

 

Impact of Communication in Healthcare