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??

I disagree. We put a huge amount of trust in medical professionals. They should extend the basic courtesy of introducing themselves.

ahe probably does Beal with a lot of people then refusing to be examined by her because they don’t understand her role and qualifications. But there is an attitude in the UK that you should just take what you are given and show deference to anyone in a medical setting. This is wrong and we need to be assertive about our health and our bodies.

@OssomMummy1

Again you have no idea of my grade to make comments of such. I wonder if its because you think i'm junior?

I was simply saying that poor attitudes towards juniors staff members are shocking and outdates and also have no place in an educational work place.

I agree with you. Thanks to this government that they are in such a mess. Still, PAs do a great job. They urgently need that regulatory body so that they can move on with their career and future. ODPs in theatres have it, why not PAs?

Sully B - 100-% agree with you.
The Foundation docs do need to appreciate that the Physician asssociates will have good local knowledge of protocols and how to get things done but the P.A. Need to understand that there role is not a training role, it is for service and to allow training time for the post grad doctors.

interestingly - the terminology is changing. We should not longer be saying junior doctors or trainees because the general population do not understand that the doctor is fully qualified as a doctor and not a medical student.

Their not there

One of my registrars made a good observation

“they can tell you what needs doing and how but they can’t tell you why”.

So they know that x and y symptoms need a and b test, but any questioning as to the mechanism behind it they falter and fall apart. They don’t have the broad knowledge doctors do. That’s just a fact.

I’m a nurse and I work with several nurse consultants. There is such a thing. They have usually done their 3 years degree level training, have gone on to a Masters, are legal trained prescribers and highly experienced. I would rather be treated by some of them than the many doctors that I know.

Oh Dear !

I think this is often the case

But what would career progression for a PA look like?

Yes they are great in their roles. But then you get some that think they are above their station and do very little, handing all jobs to the foundation doctors and just wanting to enjoy going to theatre. A rota of ward vs theatre would be the only fair thing but who would prescribe on the ward and order imaging?

It wasn't though. Virtually every post of yours you've pointed out how much more PAs earn compared to doctors. And it's not true. Band 7s earn between £40k and £45k. That's the same as a someone in their first year of specialty training - ie once the FYs are completed. And beyond that clearly you will earn far far more than a PA ever will. So your posts are disingenuous to say the least.

Should have specified I was talking about teachers. Not scaremongering at all. Just sharing experience...as is the intention of a discussion forum.

My good friend is a social worker. She trained for 3 years. Her first year employed she was given double the caseload as her team was so thin on the ground and her mentor was off sick and there was no one available to support her. Not ideal.

But it's not scaremongering to state facts. Public services have been aroded to bare bones and people are suffering because of it. Who does it serve to pretend that our public services are all top notch and fit for service when everyone can see they are all on their knees and close to collapse?

I am a public servant by the way. I'm talking from in the trenches.

That’s because medical skills can be copied by observing but not medical knowledge. There is no end to medical knowledge. ODPs, midwives, ANPs guide and help when junior doctors do something wrong technicwise. Don’t they?

Career progression at the moment is zilch in acute care, they are ward monkeys.

Personally I don’t and won’t rota them for theatres. My consultants are very strict on who they will have in theatre with them and I respect that. For big cases there are often 2 consultants, an ST7/8, surgical care practitioners and 1 space for a junior to observe and maybe hold something. I’m not going to say a PA can go over a junior who intends to do surgical and is desperately trying to get a training number. Not going to happen and the consultants would hang me anyway!

@Namechanger355 do you work in the healthcare sector?

I don’t. I flatter myself that I am fairly intelligent and have been quite successful in my field.

but I have never heard of a physician assistant. I have no idea where the stand in the medical profession, what qualifications they have and what they are allowed to do in respect of my care.

i am not being ‘snobby’ but I would expect someone giving me medical care to die today who they are and what their role is. I have never been treated by anyone other than a doctor or nurse and am always aware which one I am dealing with.

there is an arrogance in your response that we should just suck it up, and never question the care we are getting.

that attitude should have died out decades ago. We no longer need to show unquestioning deference to people in the medical field. It is absolutely fine, and indeed to question qualification and ensure we are comfortable with the care we receive.

clearly the medical prefssion need to understand this role is not widely understood. Theta is not the fault of the general public and to suggest it if this lady’s fault is just wrong.

@SullyB

Spot on.

Thats the issue, but in a triage situation it may present an issue when a patient has multiple pathologies or present atypically.

She made the right call and you're complaining??
You got diagnosed courtesy of the results of the CT scan she'd suggested, a suggestion she would have absolutely run by the duty doctor.
She did all the right things.

You were in the hands of a qualified clinician who made clinical observations and then discussed decisions with the duty doctor. She would be part of a decision-making process, not the sole person deciding on your treatment but suggesting to the doctors what she thinks might be a suitable way forward.
Was she right or was she right?

I don't understand why you're upset. Because she's too far down on the food chain in terms of qualifications? Was she holding a bucket and mop? No.
You were accurately and swiftly diagnosed and now you can have a treatment plan in place. Excellent result.

The Foundation docs do need to appreciate that the Physician asssociates will have good local knowledge of protocols and how to get things done but the P.A. Need to understand that there role is not a training role, it is for service and to allow training time for the post grad doctors

This is spot on. When I’m oncall on medical admissions, the 3 or 4 PAs there have been very useful and friendly. They know how the ward works, they know how different consultants like things and they know how to get things done. I’ve never seen issue with job roll crossover - things like lumbar punctures and ascitic taps are done by the SHOs without question. I get it must be difficult for @SullyB (who’s post was also very good!) - I suspect it’s generally more difficult on surgery anyway.

@titchy

Yes they do earn more than the foundation doctors they compare themselves to and compete for experience with.

By the way, we've had them in the States for years. They don't replace doctors, they share the workload.

My friend is a PA. I think it is a higher qualification than Nurse Practioner.

@Cravela a Physician's Assistant is senior to most (other than management) nurses surely? Now even your initial assessment had been by a HCA I could understand your annoyance. YABU. But hope you are better now?

And they are well regulated in the US. Here?

All health care professionals should introduce themselves by name and role. That’s indisputable.

I am a consultant. I often take phone calls from X ‘one of the doctors’ and I ask what grade they are. I have found that PAs often do not introduce themselves by role “I’m Y from the cardiology team”. It’s important to know. I also take referrals from paramedics, practice nurses and podiatrists whereas in previous years it would have been the GP. Sadly GPs who phone have all the patient history but have often not seen the patient face to face.
I do find that nurse /nurse/ podiatry referrals are inaccurate compared to medical ones as they are keen to safety net the patient and get them seen however I would rather see a patient who does not need admission rather than the opposite. This is the reality of the NHS with inadequate resources. It is all hands to the pump!

Realistically PAs are a solution to the staffing crisis but it’s not going to happen if junior drs hate them and their role isn’t defined well. The reality is the progression and earning opportunities will never be the same for a PA as a doctor but I can see how it must jar in the early stages of training when a PA might be earning more than an F2 with better hours.