There are three methods to take orders from physicians:
- Verbal Direct Order – in person or over the phone. Requires presence of physician. This takes place after the PA has interacted with a patient.
- Written Direct Order – having the physician spell out/write out orders and signing off. This takes place after the PA has interacted with a patient.
- Medical Directives – PAs are able to implement an already-agreed upon list of frequently delegated tasks under certain circumstances. This takes place in advance of the PA interacting with a patient.
In all cases, how the order was implemented (and method – verbal, written, medical directives) should be documented in the patient’s chart.
Medical directives allow PAs to perform various delegated acts under the supervision of a physician. The physician does not necessarily need to be present for the PA to perform these delegated tasks that have been outlined in the medical directive. Medical directives allows PAs to function more efficiently, especially in settings with indirect physician supervision.
It can be quite cumbersome to require your supervising physicians to give you verbal or written orders, or to chase after physicians (around a hospital, or smaller practice) for routine ordering of imaging, lab tests, and prescription of routine medications (narcotics/controlled substances fall out of this scope). Time is spent instead on patient care.
If there is a controlled act, e.g. an investigation you would like to order, medication that you would like to prescribe (such as a narcotic/controlled substance), or an intervention you would like to implement that falls outside of the medical directives, this is where you would require a direct order (e.g. written order) from the physician.