To expect to be examined and diagnosed by an actual nurse or doctor?

[Cravela]

Stomach pain came on suddenly and worsened over 24 hrs. Telephone appt with GP who advised hospital and sent me to the surgical assessment unit. So far so good

Staff member arrives in scrubs and takes all my details and then starts examining me. Tells me the plan (CT scan) and that she will give pain killers in the meantime.

Noticed she wasn’t wearing a lanyard/badge so I asked her her name Dr?. She says oh I’m not a doctor, ok so you’re a nurse? (No issues with that always choose to see an advance nurse practitioner when I go to the GP and I have a friend who is a consultant nurse). No she says she’s not a nurse. I was getting quite frustrated at this point because she was clearly avoiding just telling me her job role. So I straight out said can you tell me your job role please. She said she was a “physicians associate”.

I’ve never heard of one before so I googled after she left and literally anyone can be one after a 2 year course. They don’t come under the GMC or the nurses governing body and aren’t able to prescribe medicine or diagnose people??

I asked the nurse in charge if I could see a doctor or a surgical nurse and they came 10 mins later. Doctor was quite apologetic and re-examined me.

AIBU to think if you aren’t a doctor or a nurse you should tell people that before you put your hands on them??

The only nurses I have seen that stand up to the doctors of all grades are either infection control nurses or a few band 8 nurses.

The pervasive hierarchy and culture are what leads to this. Nurses are not empowered by our training and the little empowerment we get is challenged the second we enter the workforce at band 5. Those that speak up are ostracised and pushed out.

I say this as a senior nurse who has challenged doctors from when I was a student nurse to matron. I have been lucky to not have been affected by the above because of strong managers and leaders around me.

Our surgery has a PA. She is fantastic.

Could not agree with this more!

PA do their course AFTER a science degree of some sort, so 5 years university level.

They are trained medical professionals and a valued part of the team. YABU. Get a grip.

I agree with you.

as another poster said, scope and role creep is a huge problem in the NHS. The fact is, they are not a doctor and therefore should not do doctor jobs.

And, no they cannot order scans or prescribe. So they have to ask a doctor to do this. So it’s not necessarily more efficient to have them assessing, diagnosing and making a management plan — as that needs to be checked by a doctor.

Placing cannulas is very different than assessing, diagnosing and forming a management plan. Those are doctor responsibilities. placing a cannula is a suitable task for a PA.

I think in all of our discussions of roles and such we have lost the actual question behind the thread.

I would never refuse to see an ANP, PA or any other health professional. I mean when a patient presents that are seeking help (which we take for granted as being free in the UK). I think it's disrespectful.

How many people would actually refuse to be managed by a staff member who is not a doctor?

This is my experience, as well.

I wish the powers that be would stop junior doctors rotating so often. No-one likes it and there are serious drawbacks to it.

@Feckingfeck two things: one the NHS is not free, it is free at the point of delivery. Two, I take an expectation of optimal care, delivered kindly and expertly for granted yes.

For far too long in the UK we have been expected to put up with sub-optimal care delivered with zero respect. It isn't free; it has to change.

On Tuesday I had a hospital appointment. Someone in a white tunic called me for a scan. I have no idea of her name or her role. She then sat me down and asked for the questionnaire I'd completed and proceeded to go over every single question - I imagine because it's assumed the thicko patient receiving free care can't accurately complete a form. It was beyond patronising as was the assumption she could use my first name without asking.

My basic expectation is to deal with respectful humans who are able to treat me as their equal.

Vive la revolution.

Genuine question - if FYs don't rotate how are they supposed to make an informed decision about their speciality?

When some have delivered care in third world countries

🙄

The system isn't perfect but we should not take it for granted. Would you rather a mistake be made with you or another patient if the list wasn't checked? Would your life be changed if she introduced herself, she is taking an image not intimately questioning or examining you nor taking responsibility for your care so this seems a bit pedantic.

@titchy

Completely agree.

There are already many underrepresented specialities not covered enough by foundation rotations.

The old pure medical or surgical jobs don't exist anymore.

Friends son medicine in Manchester Fourth year. He makes my head spin with his tearing around different hospitals spending a few weeks on each department. So much time spent commuting between them. He's overweight, pallid skin, seriously unhealthy lifestyle just now. I marvel at his stamina.

Another friends son will be a consultant next year he has been told life will be less hectic then.

There's no logical continuity for either of them yet

• Force f1s to rotate every 4 months so they can act as service provision in shit departments they have no choice over and consultants can be arsed to train as "they'll be moving on anyway". Pay them £28k and rota them for nights and weekends. Call them "Dr".
• Pay some random people £40k to do a 9-5 Mon-Fri, with the freedom to leave a shit job if they want, give them clinic and theatre time because consultants can be arsed to train them up. Call them "PAs".

The NHS is broken

YANBU she should have introduced herself.

However the NHS is a multidisciplinary team who all work together to get the best outcome for the patient.

Would you not want the HCA to be doing your obs and notice you are deteriorating from the early warming score?

The independent prescriber nurse getting you painkillers for your condition because the junior + reg is currently occupied with the lady two bays down who is bleeding?

What about the scientist waking the consultant at 3am to let them know you have an acute leukaemia whilst the F1 is still thinking about the results?

What about the pharmacist making your chemo, when the consultant wouldn't know where to start?

The clinical perfusionist keeping your brain supplied with oxygen whilst your on bypass, sure they aren't a doctor they can go aswell.

The paramedic who has prescribing rights is okay at the scene of your accident right? They aren't a nurse or a doctor so I assume they are the same as a taxi driver?

A lot of conditions are managed using set procedures which can be initiated by someone who doesn't have MBBS after there name. If we want a NHS which is free at point of use we need to use our staff more appropriately. It is likely that PA's along with a host of other allied healthcare professionals will get PGD rights in the next few years.

As a HCP (not a doctor but I can put some letters after my name ) it doesn't bother me what the persons tittle is aslong as they can treat the condition, so I can get on with my life I am happy. Unless it involves bloods in which case send in the HCA not the F1/2 please I'm begging you!!!

👏👏👏👏👏👏👏

Your information is wrong, a nurse does 3 years training. A nurse practitioner does an additional 2.5 years training at masters level now including prescribing and are taught diagnostics and are able to diagnose, treat and prescribe organise tests etc. 1.5 years of this training they spend with a medical mentor shadowing/teaching them so a GP/ doctor. They’re also paid B7-8 depending on area and negotiated higher than this salaries in GPS.

Yep this is it.

@BabyBin the need for the scan arose from the failure of an F1 to diagnose a broken vertebrae in A&E. She was categorically told the pain was exactly the same as when I broke the L1 6 years previously. I was told that couldn't be the case as I couldn't feel pain when she pressed my spine (I was tanked on morphine). She insisted I didn't need an XRay. I insisted I did and was told I needed to be mindful of the risks of radiation. I said I wouldn't argue but could she please note I had requested a spine XRay and she'd refused it. So she spoke to a senior who authorised it. She categorically told me there was only an old fracture. In fact the T12 had fractured that day. She failed completely to listen or take on board the fact that I had osteoporosis and had had 5 rounds of zolendronate.

I am sick and tired of the incompetence and the rudeness.

@OssomMummy1 no, I don't think it's double standards at all. Airway emergencies happen in the blink of an eye, it's different on the wards and ED there's decent supervision. I'd want an anaesthetist overseeing the progression of any deterioration from start to finish so they can accurately diagnose and manage from the offset. Whether it's a tube out, machine /monitoring error, malignant hyperthermia, wrong drug administered, whatever. Even Anaphylaxis isn't always obvious and if you as the anaesthetist administer the drugs yourself, are aware of the progression of the surgery ie latex catheter going in, it's much more straightforward and you buy precious time.

Furthermore, two emergencies happen at once in two theatres. Then what? And the consultant is responsible for both. Mad. We've had two anaphylaxes in two theatres within the hour in our theatre complex in the last 6 months. One arrested. Unrelated, different drugs.

I know it's commonplace abroad and in some tertiary centres here. I'm dual nationality and it's why I work here rather than there. It didn't work there and I don't want to work in a similar system until I can see it work safely. I've worked with PAs on the wards. They're good, hard working colleagues who are a credit to the NHS, it's nothing personal.

If AAs are so safe then why do CT1s require SO much supervision in their novice period and beyond vs f1s who are allowed to see their own patients in ED and present back remotely? Whole different ballgame, even for doctors. Same with non airway trained fellows on ICU, they're very supervised.

Would you leave a foundation doctor to manage resus with regs down in minors? I wouldn't personally. It's not fair on them. I've done my time in ED, the wards, ICU and theatres so I'm only basing off personal experiences and fully respect peoples experience vary though.

@Feckingfeck haha absolutely. I'm keen to audit it but apparently I won't win and they won't be changed so I'm still digging up evidence that clear ID badges with titles are needed. It's mad we don't have them already and I fully agree with the OP that clear introductions and a badge with title on are absolutely essential

They removed our names from our uniform too, which is a nightmare when trying to run a complex job prehospital…..ALS, polytrauma etc. It goes against all human factors teaching which encourages use of names etc.

We still have grades on our epaulettes though so that’s something I suppose.

But assuming all clinicians are incompetent is very unfair.

A blanket "the NHS are crap" response really puts down the people who work very hard to keep the cogs turning in what is a broken system.

You should really be more grateful, trust me. I have seen a whole lot worse.