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Developing a role for the Physician Associate in
Rheumatology Dr Andrew Whallett
Consultant Rheumatologist
Dudley Group NHS Foundation Trust
Deputy Postgraduate Dean, HEE West Midlands
Who’s who?
ORTHOPAEDICS Trauma
Mechanical
Developmental
RHEUMATOLOGY
Severe
(often systemic)
joint disorders
GENERAL PRACTICE
Minor traumatic and ‘arthritic’
conditions
Overall frequency of Musculoskeletal disorders
Back pain
Osteoarthritis
Soft tissue disorders
Inflammatory arthritis
PATTERNS OF MUSCULOSKELETAL DISEASE
• Monoarthritis vs. polyarthritis
• Inflammatory vs. non-inflammatory (i.e. mechanical/structural) arthritis
Inflammatory/Mechanical
• Inflammatory – pressure and stretching of synovium and peri-articular structures
• Inflammation(red, warm, swollen)
• Systemic upset.
• Mechanical – prevents normal smooth movement
• Pain localized and reproduced by certain movements
• Crepitus/clicking/locking
Screening (minimum) musculoskeletal examination
• Minimum examination standing (spine, neck, upper limb)
• Minimum examination lying down (lower limb)
The changing settings in which patients are cared for
• Inpatient
• Outpatient
• Day Case
• Community
Blurring of ‘Professional boundaries’
• Focus on what patients need, rather than on who or where care is provided
• Multi-disciplinary team
• Patients
What can a Physician Associate do in Rheumatology?
What can’t a Physician Associate do in Rheumatology?
Clinical Rheumatology ‘tasks’
• History, Examination, Diagnosis
• Diagnosis
• Treatment and Management Plans
• Joint and soft tissue injections
• Disease Monitoring
Beyond Clinical Rheumatology ‘tasks’
• Data gathering and recording
• Quality Improvement
• Research
• Education
• ‘Management’