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??

@Sammykit that explains a lot- thank you. So there's little hope of a poorly performing hospital in a very expensive area just outside London ever improving then because they consistently get lumbered with the worst doctors (and nurses due to the cost of living and marginal London weighting)?

I didn't know that GPs couldn't order MRIs.

My NHS physio ordered one, it seems a bit weird that a physio can but a GP can't. (Not dissing physios, by the way, I've had really excellent treatment from them.)

Not necessarily

I got a high score and went to another city that was a lower score than london - some people score quite high on the ranking process; some people not as lucky and had to go to some other places away from peers. It meant you could end up very isolated in a city where you knew no one whilst doing fy1.

I was met with alot of sceptisim from my peers when I arrived for fy1 because I was from another city and ‘had taken one of their highly ranked rotations’. I was not popular for a while.

the scoring system was relatively new when I qualified it was for MMC - (modernising medical careers). You were scored on - 1) marks from exams 2) if you had any audits or publications 3) extra mark if you had bsc / msc / intercalation 4) answering questions based on WWYD type questions 5) a problem solving exam

a similar process has to be gone through to get INTO general practice, core surgical training, core medical training and Accs. Then after a couple of years a similar process has to be gone through AGAIN to get a training number and become a registrar. Then after that you have to CCT (another process) to become a GP or consultant in that specialty.

they brought in modernising medical careers to stop the old boys network and try to standarise us all. Great in theory.

it is little wonder people would chose to be PAs 😂😂😂😂😂😂

One of the best diagnosticians I know is a nurse who qualified as an SRN in the early 80s and worked as a theatre sister for many years. We share the same GP, and he knows we're friends. He once asked me why I thought I might have some issue or another, and when I replied that that's what SRN friend thought, he grinned and said "Well, that's good enough for me, her diagnostic skills are remarkable".

She also realised that a friend probably had heart disease. Sadly, his GP didn't realise, despite classic symptoms and risk factors, and friend died 2 days after being admitted as an emergency.

For me, skills and ability are what matters. I'd rather be seen by a competent nurse, paramedic or PA than by a doctor who is less skilled or able. Being more highly qualified doesn't necessarily mean someone is more skilled or able.

For me, skills and ability are what matters. I'd rather be seen by a competent nurse, paramedic or PA than by a doctor who is less skilled or able. Being more highly qualified doesn't necessarily mean someone is more skilled or able.

completely agree

I interview for the medical
school locally and it is illuminating. ☀️🌞

So the twerp who examined me and failed to listen, failed to take on board the fact I was tanked on morphine, told me I had to trust her because she'd been to medical school and told me I needed to be mindful of the risks of radiation if I had a spine XRay and then told me that there was no new fracture was likely not to have the best profile in the junior doctor's big black bag then. I wouldn’t be surprised. It's helpful to know. I shall take an FY1 history very carefully of anything happens again and ask for someone else if I'm not satisfied. I hope someone has told her that in relation to trusting someone for going to medical school, that Harold Shipman did that too.

Every year there are a couple of hundred graduates who have not been able to secure an F1 position. There's threads each year!

@lljkk

The last couple of years they have “created more jobs”, but there was a year they didn’t and the anxiety associated with that for fresh Graduates is immense. I think the increase is do to RTLM with Doctors added to the shortage occupation list so they can apply from all over the world and are on an equal footing with U.K. grads. That’s only for Foundation, when you get into specialty training there are literally not enough spots and they don’t create more instead people go to Australia/get stuck in non-training jobs/locum.

In addition, changing hospitals every 4/6/12 months mean quite long commutes for some. It’s not that unusual of to have one hospital for Foundation/GP/ speciality training and another with an hour and half commute which forces juniors to move every year.

Anecdotally, from scouring social media there are many Drs from abroad with 5 years experience + that cannot find jobs.

Honestly, I think that PA job sounds great. Conditions seem much better than those that Doctors get. Imagine not knowing if you got the annual leave you requested until 3 weeks before ? Imagine not being able to book more than 3 days of annual leave in succession. It’s no wonder that our Doctors are contemplating leaving/career changes.

They have also created a GP apprenticeships that don’t require you to go to university and complete a traditional medical degree you can read about it in the pulse.

The things is ….. people are getting older and living longer and we have more tests and interventions( amazing we are doing a good job), however, this increases workload in itself. It’s takes a long time to produce a Doctor so they need to plug the gaps….. viola ! The PA/ANP etc. I think we need them!

To answer the original point of the thread. There just needs to be more role definition maybe a different uniform. Tbh I think docs should be wearing a uniform too e.g colour of scrubs to indicate seniority and a picture displayed for patients so they can understand who is treating them.

My NHS physio ordered one, it seems a bit weird that a physio can but a GP can't. (Not dissing physios, by the way, I've had really excellent treatment from them.)

Well, we're getting Integrated Care Systems as a replacement for Clinical Commissioning Groups later this year so we'll see what shakes out. There will plausibly still be substantial variation from one region to another.

I wonder whether they'll create extra F1 places in three years? Remember due to the A level debacle of 2020 lots of extra medicine places were awarded so we will have loads more medicine grads in 2025...

When I was concerned my back was broken and been misdiagnosed my GP initially disagreed and said I couldn't be referred directly to a back specialist but would have to see a physio first who would decide on the next steps. Thank goodness for PPP!

Another problem here is there are vacancies but no accommodation to rent, this is Wales btw might be different in England

At the end if the day I don't mind who examines me providing they are both competent and respectful and don't continually maon about their job. In any other sector if the employee did that to the end user (customer/client/patient) theybwoukd have standards set and if things didn't change would find themselves disciplined for bringing the organisation into disrepute.

Theater thing that really gets my goat is the tendency of nursing staff to make small talk about things that are none of their business - ooh that's a funny name, ooh pink shoes, going on holiday soon - I don't want to engage on that level when someone has a speculum or needle in their hand I want them to concentrate on what they are doing rather than draw blood with the speculum or blow a vein with the canula.

I often like HCPs to have a regulatory body...

You sound lovely.

Would you berate anyone in any other work place for making small talk? They are often trying to distract the patient from what is happening and put them ease.

Perhaps you should try doing a very difficult job, with poor pay for your skill set and be constantly belittled by bosses and not respected. (Nursing)

If you hate the NHS perhaps seek your care in France, as you mentioned how brilliant it is. Or pay private?

Illuminating

😂😂😂

In regards to distribution of foundation doctors.

You often find those that academically score high can do less well in SJT brining marks more level. There are also standard at medical school with multiple exams through years of training. Along side sign off for competencies and clinical placements.

To assume that all people pass is wrong. Not forgetting how hard it can be to get a place.

These are tried individuals who have high levels of supervision throughout foundation training.

It is - I would love to share some stories.

Please do 😂

I suppose it is just very evident the kids who have pushed in that direction (no fault of parents of themselves - just wanting to do what they think is best) and the kids who organically seek out a vocational career. Most candidates really are amazing though.

Yes, I am lovely @BabyBin . If nurses can make small talk without screwing up the procedure fine. If they can't not fine. Interesting isn't it, how my GP or other doctors don't do it.

It isn't me belittling nursing staff, you've said it's their bosses which is indicative of a toxic and dysfunctional structure. All my staff are respected from apprentice to Partner. And it is wondered why NHS attitudes are so poor.

Where I can I do seek care in France or privately. One doesn't hear the incessant whinging and politicking there.

The NHS has become a behemoth and it's funded by the people for the people. Branch by branch it needs to change.

To be fair to pp the French health care system is excellent. Everyone has access to good and efficient health care via a mixture of state and private funding via insurance. I wish the UK would switch to a similar system. Instead we have NHS supporters banging on about how the only option for change would be the USA system, which IME is expensive, inefficient, profit driven and very unfair. I worked in the NHS for over 30 years and it has been crumbling for all of that time. I have also worked in USA and I wouldn't want that system here.
There are pockets of excellence here in the UK and I have been lucky to have had great treatment in 2 specialist hospitals and a couple of good departments in DGH. I am lucky to have a good GP. But the service isn't equal across the board and I have friends and relatives who have had dreadful experiences.

In a welfare state such as the UK not sure how well a partly private funded system with insurance will work. That's one of the positives of the NHS that it is free at point of care for all.

@RosesAndHellebores So you don't like HCAs, fy1 doctors or nurses that make small talk about holidays - is there anyone you do like?

What thrilling awe inspiringly prestigious job do you do that justifies so much contempt and malice for everyone else?