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’m pretty sure it was a PA who finally placed the cannula in DD’s tiny vein for her surgery when the radiologist, ward doctor and nurse had failed- that was really not great to watch. He was fantastic and worth his weight in gold just got that.

This has turned into an interesting thread.

But ultimately the PA should have introduced herself appropriately, you would expect the same of anyone in a clinical setting. With everyone in scrubs it can just be so unclear.

But OP should have enough faith in the health care system to know nobody under qualified would clinically assess a patient. Attitudes towards other health care professionals can be poor, perhaps its also due to poor education of their roles. But then again thats not a patients issue.

Faith in the health care system.....Perhaps thats where the problem lies.

It’s a different role.
many advanced care practitioners may be from a nursing or physio background. They will have done masters level training and may be an accredited prescriber and be qualified to give ultrasound guided injections. They are highly specialised and an independent practitioner .
A physician associate is there to support doctors with practical and administrative tasks within the supervision of a doctor. They are not independent prescribers or licenced to request radiation tests . The scope of their role is a grey area though and is often extended due to doctor shortages. It’s controversial.

Do you work for the NHS ? I hope not because what you've written is just not true.

Medical professionals Introducing themselves to patients is as you say a courtesy. Whether or not they adhere to such outdated rules of politeness has zero impact on their capability to provide healthcare.

I don’t give a fig if I know the name and exact job title of whoever is examining me when I’m in A&E with severe stomach pain getting triaged. I think getting me scans/tests and a diagnosis are far more important than wasting time on social pleasantries.

Im not showing deference or being unassertive, I’m merely actually prioritising my health and my body by getting straight to accessing care instead of wasting time.

I wouldn't want decisions on my health to be taken by a PA with maximum 2 years education in a very limited scope vs minimum 6 for a doctor. There is a reason they were being quiet about their actual role- its very limited and for good reason

You were absolutely right to request to be seen by an actual doctor.

Yes , being good at cannulas involves lots to practice. A P. A. doing them all the time will be very skilful.

I work with loads of physicians associates and they’re all absolutely fantastic clinicians. I don’t think it’s as simple as “anyone can become one after a two year course”, you need a sciences undergraduate degree with a good classification to do the PA masters. The PA Masters teaches the “medical model” of consultation/practice right from the start.

My best friend is a PA and she did three years of Medical Sciences with a First Class Honours and then straight onto the two year PA Studies Masters. It’s a lot more training than many practice nurses have.

PA’s are an established health care profession in the US, but a relatively new thing here. It’s part of the governments plan to backfill the shortage of doctors. Turn all the nurses, paramedics, physios, OT’s and ODP’s into Advanced Clincial Practitioners and train loads of PA’s. Move all the HCA’s into Nursing Associate rolls and then get them onto Nursing Apprenticeships to make more nurses and so on and so on. I don’t think they’d describe it in those terms but it’s exactly what’s happening in reality. It’s a shame they can’t just improve the contract for junior doctors and make their job attractive, as well medicine more accessible for people from all backgrounds.

The point is that FYs will earn more. Not sure how that's difficult to understand. A PA who's been on the same unit for several years will, as plenty has attested to here, have far greater knowledge than an F1 freshly graduated on their first four month rotation.

Good to hear that the GMC is planning oversee PAs though. Hopefully both roles will develop some respect for each other in due course.

I take your point that there should be more education about these roles. And of course we should question what is being done or given to us - and by whom. I definitely did that during my labour

that said, OP’s post simply stated that the diagnosis should have been given by a doctor or nurse and implied that the PA had done something wrong because she was apparently too low in the food chain

utter nonsense and incredibly insulting- she could simply have asked for further info on the PA role

many PAs are more qualified than nurses. Just because people are not aware of something, does not give them a right to judge

we will see more varying roles like this in the NHs in future - there does need to be more education to avoid confusion but they serve a vital role when our public services are becoming more and more stretched

PAs aren’t that new in the U.K. They’ve been in the NHS for almost twenty years as they were first introduced in 2003.

Actually this is so insulting to nurses who are trying to do their own job and being forced not by doctors but by the government to take on more and more tasks that should be for the doctors but as usual too much pressure and not enough of any role to go around. People like u have no idea of the reality of health care these days and u would do ur self a favour as to learns the roles of nurses, and nursing associates before u make ur stupid comments.

Everyone should introduce themselves to a patient every single time. And lots of sweeping generalisations on this thread! I am charmingly still a “junior doctor” despite having been a doctor for well over a decade and having vast experience. In any other field I wouldn’t be so infantilised!

No you are a postgraduate doctor…. The term junior doctor should not be used any more.

The OP would have been seen by the doctor anyway after the CT scans came back for diagnosis and treatment plan. Her making a fuss to the PA during initial examination was entirely unnecessary and rude.

Compared to how long doctors and nurses have been around that is incredibly new!

people sometimes only go to hospital once or twice in their lifetime. People understand what a nurse is and what a doctor is.

I bet if you did a survey of the general population now 80% would never have heard of PAs let alone understand their role and qualifications.

it is never rude to question medical treatment.

this attitude needs to change.

we should all question our care when we are confused or feel uncomfortable.

The GMC are to take on the role of regulator for PAs in late 2022.

Agree with this - you are simply a doctor engaging in postgraduate training. “Junior doctor” should be scrapped - it’s hugely insulting and can be dangerously ambiguous

She should have identified herself and her role.. but as with any profession there are very good PAs and bad ones... they are not failed medics on the whole, they are mostly people who have retrained from another career path.. done may have considered medicine but been unable to do it for all manner of reasons.. as long as they work within their remit and levels of competence

Move all the HCA’s into Nursing Associate rolls and then get them onto Nursing Apprenticeships to make more nurses and so on and so on. I don’t think they’d describe it in those terms but it’s exactly what’s happening in reality.
@ZealAndArdour
Exactly what's happened in our trust. I was a HCA for 13 years, various departments, 2 years training as a NA , now 23 of us in the trust. I've just applied to do my nursing degree apprenticeship (15 months) and the full nursing degree apprenticeship (3 years) especially for HCA

I couldn’t agree more. It is a term that still gets used far far too much and incredibly frustrating. I’m on the countdown to my CCT date and cannot wait now!

Posted early.. they can be very useful members of the team. Also you will increasingly see more of them as you cannot recruit GP's for love nor money .. they aren't out there and the ones that are, are leaving. It doesn't matter what any one wants or how loud they shout, you cannot magic them out of thin air. Especially when the ones left are the ones being shouted at, funnily enough they have had enough. ...PAs are seen by the powers that be as a way to fill that gap.

OP I think there's been a bit of a misunderstanding here.

1. The lack of title on ID badge is a massive issue at our trust ; we aren't allowed our title on it! It drives me mad and it's something I'm fighting to change as doctors turn up to cardiac arrests and no one knows who is who, who is senior, what department everyone is from etc. It's dangerous but not our fault as employees unfortunately.

1. PAs are a qualified medical professional who have more freedom and diagnostic ability than the majority of nurses. They should've stated their title, I absolutely agree with that. But they work at the level of a junior doctor, they just can't order scans or prescribe without someone checking it. They will in time have the ability to prescribe, like advanced nurse practitioners and pharmacists once they've done an independent prescribing course. To say you want an actual nurse to diagnose you is no different. They're all allied health professionals and their opinions are valid. Furthermore, ALL junior doctors work under supervision, like the PAs do. As a foundation doctor, yes they can request scans but certainly for FY1s in a&e, every single patient plan needs to be discussed with a senior first. The same will be for the PA. They won't be able to diagnose you alone for many cases, like the FY1s. They need to take your history and then present it and discuss together with a senior. In A&E this is done out of earshot of the patient so you won't know all juniors are doing this. It is documented in the notes who the senior is they've discussed it with, for medicolegal reasons.

I've honestly not worked with many PAs. There just aren't many yet in my trust. I am generally on board with them as long as they do night shifts, which in my old trust they didn't and took day shifts from doctors and meant the drs ended up doing more nights. I am not on board with, however, anaesthetic associates as i find the concept unsafe. Story for another day!

Unrelated but just for anyone that hasn't met an advanced nurse practitioner before, they are absolutely fantastic in a&e and are worth their weight in gold. We need so many more!

Hope you're feeling better

You're being ridiculous. A physician associate IS highly trained.

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

"Entry requirements

You’ll usually need a bioscience-related first degree to get onto one of the training programmes available. Undergraduate integrated Master of Physician Associate Studies programmes are now available and these courses require A-levels or equivalent for entry.

Alternatively, if you’re a registered healthcare professional such as a nurse, allied health professional or midwife you can also apply to become a physician associate. There is also a level 7 apprenticeship for physician associates. Apprenticeships give you the chance to earn a living while gaining your qualification.
Must have skills

Don’t forget – academic qualifications aren't everything. You’ll need to be able to demonstrate experience of working with the public, an interest in health or social care, the right values to work for the NHS and excellent communication skills.

Wherever you work, you'll have direct contact with patients.

Training and development

Physician associate training usually lasts two years, with students studying for 46-48 weeks each year and involves many aspects of an undergraduate or postgraduate medical degree. The training focuses principally on general adult medicine in hospital and general practice, rather than specialty care.

There will also be 1,600 hours of clinical training,