Educating the soon to be doctor

[ChrisPAinED]

Okay so this is something I witnessed and didn't actually get involved in let's get you some background. The hospital I am at isn't a academic hospital it's community practice but a lot of our physicians do let med students shadow. 

I was working the other night and I was at the nurses station ordering something and I was hearing this ED doc ask the medical student what would he do for a patient that presents with migraines in the ED and that led to a CT and some basic labs then the doc said all of them were normal then the med students asked about the exam and history (personally I recommend checking that first but this ain't about me) and the scenario pt has hypertension something like 160/80 and the medical student was told to make a plan of action and the medical student said he would prescribe a antihypertensive drug and discharge with follow up instructions which the doc called out the same concern I thought while hearing it. In the Emergency department your job is to look for emergencies, treat emergencies, and direct patient care from there. If there isn't a emergency or anything that needs a acute treatment like a asthma attack it's best to not prescribe a drug for a suspected chronic condition like hypertension. There is a chance that it could be white coat hypertension and then you can cause there resting at home BP to be low which can make things worse. The better option would be to note it and leave a note for the PCP to read on follow up like this "John Doe presented to me with migraines after investigating with a CT some basic chemistries and a blood count I determined it's very unlikely a emergency and decided to discharge pt was hypertensive but not a hypertensive urgency I recommend a evaluation of the patients blood pressure for better long term patient health no medications were prescribed but OTC drugs were recommended along with followup" 

 

This may have been boring for PAs to read and students but there is some good learning points here that can be helpful for new PA students so please ask if there is any questions and PAs tell me would you agree it's best to leave chronic condition management to the PCP or do you think you should take initiative and try to address it during the visit? 

[EMEDPA]

I only address chronic issues in the ED if the ED is the pts pcp....for example pt comes into the ED and is noted to have a bp of 180/110 on 5 consecutive visits and can't get into a local pcp for whatever reason (insurance, no appointments for 6 months, etc). I will discuss dash diet, wt loss, smoking and alcohol cessation, etc and start them on a low dose antihypertensive and refer them (again) to a provider in the community.