To all of my medical friends and colleagues, especially to PA’s, NP’s, and Nurses, I need some guidance.

Is it acceptable for a specialty surgeon, for example and orthopedic surgeon, to leave routine postoperative care to a PA and Hospitalist and never see a patient postop until the office follow up 1 to 3 weeks after discharge? I ask because there are surgeons at one of my primary hospitals who maintain that they do not need to round on patients after routine elective surgery as long as the Hospitalist is dealing with the patient’s medical issues, and the surgeon’s PA sees the patient and keeps the surgeon informed.

The question has arisen because regulation language has been proposed at one of my primary hospitals requiring the surgeon to follow the patient for at least 48hrs after surgery. The fact that I am dismayed by the need for such a regulation tells you where I stand, but I am an old dinosaur. Perhaps the modern standard of care has changed, and it is perfectly acceptable for a surgeon to delegate routine postop care to a PA as long as the patient is doing well and there are no complications. What is the current practice? Say a healthy 70-year-old has an elective hip replacement. Is it acceptable for the postop care to be handled by the surgical PA with medical management by the Hospitalist? Does the operating surgeon have any duty to see that patient in the hospital if the PA is able to tell him/her that the patient is doing well with no surgical-related problems?

I was trained in an older, harsher school that required hands-on care of any patient, no matter how routine the procedure. But in those days, we didn’t have surgical PA’s. The Physicians Assistant was a new concept. Most of the PA’s I knew were military and were involved in outpatient care on isolated duty stations, not seeing routine postop surgical patients.

Times and practice have changed. Mid-level providers are given much more responsibility now than when I was in training. I am married to a Nurse Practitioner and am cognizant and sensitive to the issues of their scope of practice. Still, I have difficulty in embracing this idea that a PA can be the only one responsible for postop care in any surgical patient, no matter how stable. Am I wrong? Am I simply behind the times?

Contrary to popular belief, I can change with the times. If this is the way of the modern world, I will accept it, albeit reluctantly.

 

Bruce Davis, MD, is a Mesa AZ based general and trauma surgeon. He finished medical school at the University of Illinois College of Medicine in Chicago way back in the 1970’s and did his surgical residency at Bethesda Naval Hospital. After 14 years on active duty that included overseas duty with the Seabees, time on large grey boats and a tour with the Marines during the First Gulf War, he went into private practice near Phoenix. He is part of that dying breed of dinosaurs, the solo general surgeon. He also is a writer of science fiction novels. His works include the YA novel Queen Mab Courtesy, published by CWG press (and recently reissued by AKW Books as the e-book Blanktown). Also published through AKW Books are his military science fiction novel That Which Is Human and the Profit Logbook series, including Glowgems For Profit and Thieves Profit.

The Website: http://www.thatwhichishuman.com
The Blog: http://www.dancingintheor.wordpress.com