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Life as a Physician Associate in Cardiology

In this post I describe my first experience working as a qualified PA in Cardiology! If you’re a student due to have placement in Cardiology or just someone interested in how Cardiology works, this can provide some helpful insight.

To start off, I’ll explain the terms of my employment because there are lots of different PA jobs out there and it can get confusing! I’m currently on a 1-year fixed term contract for newly qualified PAs in which I am rotating in Specialist Medical Services. Specifically, the rotations are Cardiology, Renal and Haematology with 4 months in each. Since I started mid-March, I’ve recently completed my first rotation in Cardiology and am now in Renal. Once my contract is up next March, I will be able to apply for a permanent position as an experienced PA.

Cardiology: Setting the Scene

The Cardiology department at my Trust is a tertiary care centre which means it provides highly specialised care and treatment. The department is made up of Consultants specialising in heart failure, electrophysiology (the electricians), interventionalists (the plumbers) and others. They also have cardiac physiologists, cardiac sonographers, specialist cardiac nurses and more. It’s a big department with lots of different people doing lots of wonderful things.

On the wards, its split into the Acute Cardiac Centre (ACC), where patients are less stable and/or need cardiac monitoring, and the normal cardiac wards. Each week the consultants swap around as do the doctors. This means that Mondays can be quite hectic as the team get to know a new set of patients. At first, I was also rotating around the wards but after highlighting the lack of continuity to my supervisor, I was put on ACC permanently. This allowed me to get to know the patients making the ward rounds easier week by week. It also allowed staff to get to know me and my role.

Day-to-day

I would arrive in the mornings and print out a handover sheet for the doctors and myself before the ward round started. Then myself and whichever doctor(s) were on with me would start preparing the notes. That entails writing the patient's details, the date, time etc (very important to document everything clearly!) If the patient was new, we would write a little summary of why they were there and their background so we could present to the consultant. If the patient was known to us, we would simply write in the latest blood results and observations (temp, heart rate, blood pressure etc).

The patients on the ward included people with heart attacks that had had stents (PCI) or balloons (angioplasty) in the catheter lab. Others were patients with arrhythmias which needed ablating – scarring or destroying the tissue causing the abnormal electrical signals. Others had heart failure which had caused them to become fluid overloaded (fluid in their lungs, lower limbs etc) which is known as decompensated heart failure.

Ward Rounds

Once the Consultant arrived on the ward from their hand-over, we would start the ward round. Before seeing each patient, we would update the Consultant on anything that had changed and any results from investigations. The patient would then be seen, asked how they were feeling and told about the plan of action which we would document in the notes and job book for later. If we had more than one doctor covering, one would go off and start doing jobs while myself and the other doctor continued the ward round.

Once the ward round finished (and this could take anything from 2-5 hours depending on the consultant and how sick the patients were) the ward doctor and I would get together and make sure we had the full list of jobs written down. Examples of jobs on cardiology include ordering cardiac echos (which I can do as a PA), ordering x-rays (which I can’t do as a PA*), preparing discharge letters and speaking to other specialties for advice e.g. speaking to microbiology about appropriate antibiotic treatment and duration.

Rest of the day

So the rest of the day would be dedicated to completing the job list, each of us ticking off the tasks we’d done. As a PA I would take the jobs that I knew I could complete myself and leave jobs like prescribing to the doctor. Alongside this are the constantly evolving situations on the ward like a patient having a fall or scoring on their observations or complaining of pain and needing an analgesia prescription. If I felt I could handle the situation, I would go and review the patient myself and then come back and discuss with the doctor before implementing a plan.

An example would be a patient complaining of chest pain. I would take a history and examine the patient. If I thought it was due to musculoskeletal pain (likely in patient who had CPR) then I would present back to the doctor and recommend analgesia which they could then prescribe. If I thought it was cardiac, I would get an ECG and observations done. If the patient had a GTN spray I would recommend they take it (not in patients with aortic stenosis!) and see if the pain eased. Meanwhile I would discuss with the doctor and move forward with a plan depending on the observations and developing symptoms. Here is a pic of some of the doctors I worked with in Cardiology.

Clinical Skills

The nurses on ACC are amazing and trained to take bloods and cannulate so I was surprised that I wasn’t doing these daily. Saying that, it’s better to practice when you can because when the nurses aren’t able to bleed, the next person they’ll come to is you.

Other than bloods and cannulas, I did some arterial blood gases, blood cultures and NG tubes. I didn’t have the opportunity to catheterise on this rotation so if I need to in the future I would probably have to refresh my skills because I haven’t done one in ages! Don’t be afraid to say that you aren’t confident doing a clinical skill. Its better to be shown and do it properly than second guessing and doing it wrong at the patient’s expense.

Preparing for Cardiology

No amount of reading will prepare you for working on the wards, you’ll learn best by being there! But hopefully I’ve given you a decent overview and you have some idea of what its like. Here are some things you can read up on to prepare for cardiology

  • How to read ECGs

  • Echos and the important bits to look out for on the reports

  • 24 hour ECGs

  • Myoperfusion scans

  • PCI

  • Arrhythmias

  • Ablations

  • Heart failure

  • Coronary vessel anatomy

I could make an endless list! But these are common topics that are discussed, some of which I had no idea about when I started. If you’ve made it to the end, I congratulate you and hope its been helpful.

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*check out my previous blog post https://www.notadoctor.co.uk/single-post/2018/07/21/Who-are-Physician-Associates-and-what-do-they-do to find out more info.