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??

@feckingfeck clearly the GP's phone triage effectively got the OP where they needed to be (hospital) for the investigations they needed and which could not be provided at the GP surgery.

We don't know what the OP said to the GP but it was self-evidently enough to suggest that an issue requiring rapid hospital care was a significant possibility - what would the GP seeing the OP have added to the situation apart from a long delay?

An ANP is different entirely. They are great and a huge support to junior doctors. As PPs have said they often have years of experience and I would happily be diagnosed and managed by one.

PAs have a much more limited role and in a surgical assessment role usually do the initial consultation which will be discussed with a senior who will order imaging and prescribe where necessary. To be honest they may know more in a specific area than an FY1 but not an FY2 especially this time of year. The PA isn't trying to take you to theatre so in this environment their role is appropriate. Not introducing themselves can be common to avoid "confusion" but can also be dangerous as it clouds a patient's expectations.

My grievance with PAs is more linked to pay and working conditions. You will never see a PA not take a break or stay behind to sort out a patient. (Except one I worked with in gastro- she was fab possibly because she was an ex ICU nurse) the ones with nursing backgrounds are brilliant but then again I suppose they are more like ANPs!

Because the amount of patients referred on history alone that end up being discharged from the hospital is shocking, we at time end up doing the job that a GP could have easily done.

There seems to be a massive shift to just refer, during the covid peaks this was horrendous and the amount of medical referrals was unsafe and unachievable.

I was saying it would make a better referral to. I.e is the GP found no bowel sounds the referral would then be treated differently and possibly more urgently. So it can affect patient care.

Yes. This is exactly this. A doctor oversees their work and they refer anything that needs to be referred on.

the only issue here is the lack of Id badge and the lack of her explaining her role. This is not acceptable

@VirginiaQ

Not entirely true..

They cant prescribe or order radiation. They have no governing body that will take this responsibility as they have only trained for 1 year and have very limited clinical exposure. The gaps in their knowledge can be shocking. However, when in a niche clinical area or as triage in a speciality they can work well. I wouldn't say they are between a nurse and a doctor though. I know they consider themselves at FY2 level 😂 this is often what causes the issues!!

Depending on your CCG, GPs can't order an MRI, far less a CT scan.

It's often less to do with hierarchies and assumed competence level and more about financial sign off.

@Cliftontherocks

Agree.

But they get paid more than the doctor who orders their scan and prescribes for them 🤨 and work less hours too 🧐🤨 thank you NHS 👏

It depends on the history given, clearly, and none of us knows that - so asking why the OP wasn't seen by the GP is unhelpful for this case given that it was clearly appropriate management.

Your statement that other GPs have not appropriately managed other patients is not really relevant to this case. I am fully aware, on a professional level, of what was happening in primary care during the pandemic.

Reallg? I (well, my son) saw a nurse consultant in Paediatrics just a couple of weeks ago. She introduced herself as a ‘nurse consultant’ and her name badge said ‘nurse consultant’.

She also diagnosed my son correctly - the doctor who saw him a couple of hours earlier had got it wrong.

(by the way, I agree with many of your reservations about PAs @Feckingfeck - not trying to be needlessly antagonistic!)

Physician Associates are trained health care professionals and can be very effective in a service / specialty as they are often more familiar with unit protocols etc. However they don’t have the breadth of training that a medical graduate does. The idea is not that they replace doctors but do some of the service roles ( taking bloods , putting cannulas in, organising tests) ina support role to the medical staff.

In this case the OP should have actually had an ultrasound scan, very effective to image the gallbladder and prevents the patient being irradiated which happens in a CT. I wonder if a senior doctor might have said no to CT if they had examined the patient themselves.

I work in Primary Care, and Physicians Associates are absolutely fantastic. They are well trained, and some of them are just as good as a GP. They get given a hard time by people like you OP, but don't write them off just because you don't understand the role. You are in good hands with a PA and they always get their consultations signed off by a Doctor.

Literally anyone can become a parent without any training! Physicians assistants are a full part of the multiprofessional team with a role that has parameters, as do others
And they are regulated by the Health and Care Professionals Council, so you can stop worrying.
But they should have introduced themselves!

@Cravela

Just seen the update.

I would definitely have expected a GP to examine this patient. This could have been managed as an outpatient with an USS?! (Difficult to be sure without the full story)

The referral would have been batter with examination findings if they deemed same day referral necessary.

OP is not telling a story where OP received poor care, wrong diagnosis, or wrong treatment. OP has not suggested that she had different treatment plan or diagnosis after doctor examined OP (compared to what PA said). Literally "anyone" is being encouraged to become doctor or ANP nowadays, too. I'm leaning towards YABVU.

@Feckingfeck Well indeed, difficult to know without the full story. Very easy to say that it could have been managed in OP in retrospect. Some GPs do over-refer and under examine but we really can't know that from the posts (even the ones that give the benefit of hindsight).

Tell me about it!

But equally some are great.

During FY2 I worked in a practice that rarely referred patient same day and their referrals were great and appropriate .

Some others get a name for themselves 🤦‍♀️ its when it becomes litigation medicine that really pisses me off. I still stand by there is no excuse for not seeing and examining a patient (unless its that clinically urgent that it would be unsafe)

Have done my fair share of surgical assessment work when training and the amount of "tummy pain- to be seen by surgical team" i mean you would think the patients self referred sometimes 😂

Guess its like any job though, some are better than others.

Might re-train as a PA.... less responsibility and good pay for it too 😂

Diagnosis is now largely done by imaging - who sees you is pretty irrelevant !

What she did wrong was not introduce herself. I'm just hospital admin and it's the first thing we do - there's an actual campaign about it, "Hello, my name is..."
She should have told you her name and her job title. I could see this role being invaluable at a busy A&E. This is what they do. www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/physician-associate

The fact they frequently conceal their role and have gone from Physician Assistants to Physician "Associates" tells you all you need to know.

There is no comparison between the two roles. I say that as someone who was involved in the introduction of Physicians Assistants at a teaching hospital in the 90s. There was no requirement for a degree, the training wasn't 2 years and the level they worked at was entirely different to a Physician Associate. Nor was the training standardised from trust to trust in any way. Physicians Assistants were trained to take blood, do ECGs, cannulate etc, not examine patients and order tests.

My grievance with PAs is more linked to pay and working conditions. You will never see a PA not take a break or stay behind to sort out a patient. (Except one I worked with in gastro- she was fab possibly because she was an ex ICU nurse) the ones with nursing backgrounds are brilliant but then again I suppose they are more like ANPs!

So, you wouldn't have a grievance if everybody took their breaks, was appropriately paid etc.? And, I'm going to say that the standard/dedication of practitioner varies in every role so I'm not minded to think there's anything particularly informative about your anecdote. Particularly as there are too many stories of nurses who stayed behind to do something for one patient, the relative of another patient wanted them to do something which went awry and then lodged a grievance against that nurse who was trying to do the right thing by one patient and for whom, plausibly, fatigue got in the way. Lots of HCPs work when they shouldn't because there's no option (staff shortages) but that ends up being abused with consequences for themselves and patients.

We should all support decent working conditions and patient safety. I'm also fully behind people being paid appropriately.

'they will likely have a lot more clinical experience then say the foundation doctors or newly qualified nurses' - I can't see how.

We have two - both are biological science graduates who did the PA course and are being mentored and supervised. I'm personally sceptical about the value of these roles and the mentoring and supervision is taking more GP time that the value added but English government policy and funding is promoting them. There are other 'not-a' roles the government are funding and promoting mostly in primary care. Am sceptical about the government's good faith in this area of health policy.

allied health professionals are the future
they are cheaper and well qualified

I'm completely confused by this thread. PAs are the role between a nurse and a doctor.

My friend is a Physician Associate. She studied for a nursing degree (3 years full time) then worked her way up to a Band 7 role over 10 years. She then went back to university full time for 2 years to become a Physician Associate. She absolutely knows her stuff.

I've been through the hospital system myself a couple of times and felt far more confident with the ANPs than the junior doctors who mostly didn't seem to have a clue what they were talking about.

www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/physician-associate