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Take ownership of prevention

BySam Dyer, PA-C, MHS

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A recent article on prevention caught my eye. It made the bold statement, “All PAs should take ownership of prevention, which is often considered the province of the primary care provider.” Does that include me? Probably.

After a few minutes of contemplation, I came up with the following short list of health maintenance/prevention areas that influence orthopedic care: obesity, inappropriate narcotic use, smoking status, psychological health, aging concerns, environmental considerations, fitness, heart health and nutrition.

I’m sure there are more. These are the factors that occupy significant pieces of our patients’ lives. Do you acknowledge these in your discussions with patients? Do you offer recommendations?

It is tempting to simply shelve health concerns that, at first blush, don’t seem to be related to bones, muscles, joints, ligaments and tendons. It’s tempting to say, “I’ll let primary care sort that out.” But what if the patient doesn’t make regular trips to their primary care practitioner? How much of a nudge should we be giving to our patients to address ancillary health issues that influence their orthopedic health?

Here is my own list of items that I think warrant a little more attention during an orthopedic visit — worth at least a brief mention if not discussion. Not only do they let your patients know you are paying attention to their whole person, but some can also increase your coding level as well. In parentheses, I’ve include potential referrals out of orthopedics to truly follow up on healthcare for these patients.

• Obesity: What are your plans for weight loss? (primary care provider, nutritionist, GI)

• Narcotics: I don’t recommend narcotics for this condition. Let’s talk about what else will help control your pain. (pain management, psych)

• Smoking: Smoking can slow your bone healing. What are your plans to quit? (primary care provider, community health, psych)

• Psychological health: Do you feel your depression/bipolar symptoms are under control these days, or have they worsened with this injury? (primary are provider, psych)

• Aging: Who is helping you get around the home/take care of your property/animals? (social/community health care)

• Environmental: Will you be able to get up/down stairs safely? (PT/OT/home health)

Yes, we are orthopedic specialists, but as specialists we can still maintain a broader perspective on health. A few brief moments given to overall health care will make a more complete delivery of services for our patients – and ultimately, I believe, improve their outcomes in orthopedics.

Reference:

• Conlon JL. Three levels of prevention. PA Professional. January 2012. Available through the American Academy of Physician Assistants.