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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Should we specifically be asking to be seen by a GP when booking a GP appointment ?

66 replies

Gigihadr · 06/07/2023 23:34

https://hansard.parliament.uk/commons/2023-07-06/debates/D98F2ABE-7B33-4748-B88E-ED7243469131/PhysicianAssociates

poor girl died after being seen by a physician associate and at no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor. So sad ☹️

OP posts:
LunaTheCat · 06/07/2023 23:48

I am a GP and this is horrific.. poor woman and her poor partner and family.

TurquoiseDress · 06/07/2023 23:50

This is so awful, she went to the surgery twice in the space of a week

If she'd been sent to A&E with a query DVT the outcome likely would've been completely different

Wow it's frightening reading that account Sad

Poor woman and her family Flowers

justasking111 · 06/07/2023 23:55

So sad. Have never seen an associate but have been helped twice by a nurse. So I wouldn't insist on a GP in the first instance.

Mumtothreegirlies · 07/07/2023 00:01

Very sad.
unfortunately you can’t always rely on even GPS to diagnose serious conditions either.
mybaby was critically ill. It was very obvious when I took her to the gp at 5 days old yet I was told she was fine, after that she saw 6 doctors at a local hospital and 4 other doctors including senior consultant at a&e and all said she was fine. At 18 days old they discovered she had liver and kidney failure, sepsis, severe dehydration with all her skin falling off and had lost 20% of her birthweight. She’s now brain damaged and suffers dangerous nocturnal seizures. She’s lucky to be alive.
my brother went through Similar as a newborn it took several doctors and 6 weeks to diagnose his pyloric stenosis.

Mumtothreegirlies · 07/07/2023 00:03

LunaTheCat · 06/07/2023 23:48

I am a GP and this is horrific.. poor woman and her poor partner and family.

As a GP what happens if you fail to notice a baby is severely unwell despite lots of symptoms? And what happens if that baby nearly dies and suffers brain damage? Would this be grounds to be struck off?

Spinewars23 · 07/07/2023 00:10

Gp’s know zilch, nada

it took a complaint to know where. Fibroid was lodged and even now I do not know type expect it causes problems daily and in the lining considered free of endo?!? My GP told me the sonograher would have told me everything despite the west Suffolk hospital scan info sent saying do not ask the songrapher.. instead I had to hear well I think you’ve a fibroid, but you’d be rolling around in pain… female gp in Suffolk gp practise knew nothing.

as mum say’s you’ll waste time seeing gynaecologist who say’ll dear it’s the menopause…

lol Great Britain

Gigihadr · 07/07/2023 00:11

it looks like the GP surgery made “a decision was made not to employ physician associates going forward” after this happened.

OP posts:
Medstudent12 · 07/07/2023 00:14

@Mumtothreegirlies I’m so sorry that happened to you but if she saw ten doctors she must have been a tricky presentation of her illness. And children rarely get so sick. Personally whenever I saw babies I erred on the side of caution. I now only treat adults in my specialty anyway.

I’m a doctor. I’ve read the debate linked. She wasn’t a rare case like your lovely daughter. This 30 year old woman had clear risk factors and symptoms of a pulmonary embolism. I’m a doctor and sure most medical students would have worked out the diagnosis for this 30 year old who died.

Physician associates should not be working about their level of expertise. They are meant to assist doctors are being given scary levels of responsibility.

Gigihadr · 07/07/2023 00:15

Spinewars23 · 07/07/2023 00:10

Gp’s know zilch, nada

it took a complaint to know where. Fibroid was lodged and even now I do not know type expect it causes problems daily and in the lining considered free of endo?!? My GP told me the sonograher would have told me everything despite the west Suffolk hospital scan info sent saying do not ask the songrapher.. instead I had to hear well I think you’ve a fibroid, but you’d be rolling around in pain… female gp in Suffolk gp practise knew nothing.

as mum say’s you’ll waste time seeing gynaecologist who say’ll dear it’s the menopause…

lol Great Britain

This is a thread about being seen by physician associates

my understanding is that physician associates haven’t been to medical school but are doing the job of a GP to fill the gaps

OP posts:
Medstudent12 · 07/07/2023 00:16

Spinewars23 · 07/07/2023 00:10

Gp’s know zilch, nada

it took a complaint to know where. Fibroid was lodged and even now I do not know type expect it causes problems daily and in the lining considered free of endo?!? My GP told me the sonograher would have told me everything despite the west Suffolk hospital scan info sent saying do not ask the songrapher.. instead I had to hear well I think you’ve a fibroid, but you’d be rolling around in pain… female gp in Suffolk gp practise knew nothing.

as mum say’s you’ll waste time seeing gynaecologist who say’ll dear it’s the menopause…

lol Great Britain

I’m not a GP. I’m a hospital doctor. I certainly wouldn’t say they all know nothing. It’s a shame you had a bad experience but I wouldn’t tar the entirety of a profession with the same brush.

I can’t quite understand what you’ve written but go and see a different GP if you’re concerned. GPs have to make decisions with very limited resources. If you’re upset with this then we all need to vote differently at the next election.

Medstudent12 · 07/07/2023 00:23

Gigihadr · 07/07/2023 00:15

This is a thread about being seen by physician associates

my understanding is that physician associates haven’t been to medical school but are doing the job of a GP to fill the gaps

You’re correct. They do a 2 year masters course rather than a 5/6 year medical degree. They also don’t sit postgraduate exams like doctors do or do formal training like we do. They are often favoured by hospital consultants for training and opportunities as unlike junior doctors they don’t rotate to other hospitals. This impacts upon doctors training.

They also don’t have the formative on call experience from out of hours on call shifts all doctors do early in their career. For example most have not done night shifts as they cannot prescribe so you cannot really have them independently covering wards alone at night.

They can be useful in a narrow defined role, but most get bored of basic tasks assisting doctors and push for career progression. Lots could have been doctors but became PAs instead. They have a better work life balance and the course is shorter.

I’ve worked with some great PAs, but many don’t understand the limits of their short training and their complete absence of formal post university training that doctors undertake.

A GP has worked as a doctor for 2 years (foundation programme, long hours). Then done a minimum of three years training as a GP (1 year hospital specialties, 2 years GP) and passed royal college or general practitioners exams. Most GPs have done other specialties before or they locummed for a few years before becoming GPs. So it’s common they’ve been doctors for much longer than 5 years when they qualify.

So a PA is very different from a GP and the tories plan to use them to patch up the nhs is terrifying.

bonfirebash · 07/07/2023 00:31

I have an appointment next week that's with a clinical pharmacist. But I'm actually hopeful as it's about my thyroid and being under medicated

Surely the other issue is that even I know calf pain could be a DVT and if I had calf pain and was breathless it could be a PE. How could they miss that?

Medstudent12 · 07/07/2023 00:36

@bonfirebash as a doctor I love working with pharmacists. In hospital they spot lots of our prescribing errors and are super knowledgeable. A phamarcist reviewing regular meds in GP sounds very sensible. Them seeing an undifferentiated presentation wouldn’t be. That’s a good use of other health professions who aren’t doctors. The PA issue is different, this PA shouldn’t have been seeing undifferentiated presentations. It’s scary.

Medstudent12 · 07/07/2023 00:37

And @bonfirebash you’re spot on. They really should have spotted it 😞 that poor woman and her family. It’s awful.

Medstudent12 · 07/07/2023 00:38

Also if anyone interested PAs get paid more than lots of doctors. Despite not being trained to prescribe and having less training. Hence doctors striking so hard.

bonfirebash · 07/07/2023 00:47

Medstudent12 · 07/07/2023 00:36

@bonfirebash as a doctor I love working with pharmacists. In hospital they spot lots of our prescribing errors and are super knowledgeable. A phamarcist reviewing regular meds in GP sounds very sensible. Them seeing an undifferentiated presentation wouldn’t be. That’s a good use of other health professions who aren’t doctors. The PA issue is different, this PA shouldn’t have been seeing undifferentiated presentations. It’s scary.

Ive actually changed doctors
Seeing the pharmacist as my thyroid symptoms are back and am massively under medicated

If I say that my last doctor started me on 25mg thyroxine and I am 5ft 10, and you look at the NICE starting dose guidelines.... it was like trying to treat my hashimotos with homeopathy

MissTrip82 · 07/07/2023 00:50

Nobody wants to do the work it takes to be a doctor any more. There’s a real generational change. People just will not do it. And there’s a cost to taking the easier path.

I work in an icu and we really wonder how we’re going to staff it long term. A
solid ten years of grueling training after university to become a junior consultant (so still not an expert) is a really hard sell now.

TaylorSwiftFan · 07/07/2023 01:15

This is awful.

Do PAs exist in Scotland? I've only heard of them in the last month?

Gigihadr · 07/07/2023 03:46

Medstudent12 · 07/07/2023 00:23

You’re correct. They do a 2 year masters course rather than a 5/6 year medical degree. They also don’t sit postgraduate exams like doctors do or do formal training like we do. They are often favoured by hospital consultants for training and opportunities as unlike junior doctors they don’t rotate to other hospitals. This impacts upon doctors training.

They also don’t have the formative on call experience from out of hours on call shifts all doctors do early in their career. For example most have not done night shifts as they cannot prescribe so you cannot really have them independently covering wards alone at night.

They can be useful in a narrow defined role, but most get bored of basic tasks assisting doctors and push for career progression. Lots could have been doctors but became PAs instead. They have a better work life balance and the course is shorter.

I’ve worked with some great PAs, but many don’t understand the limits of their short training and their complete absence of formal post university training that doctors undertake.

A GP has worked as a doctor for 2 years (foundation programme, long hours). Then done a minimum of three years training as a GP (1 year hospital specialties, 2 years GP) and passed royal college or general practitioners exams. Most GPs have done other specialties before or they locummed for a few years before becoming GPs. So it’s common they’ve been doctors for much longer than 5 years when they qualify.

So a PA is very different from a GP and the tories plan to use them to patch up the nhs is terrifying.

That is absolutely terrifying !!!

OP posts:
Bubbleses · 07/07/2023 04:08

Medstudent12 · 07/07/2023 00:38

Also if anyone interested PAs get paid more than lots of doctors. Despite not being trained to prescribe and having less training. Hence doctors striking so hard.

Pardon my ignorance but I’ve never even really heard of a physician associate! I suppose I have had limited contact with medical professionals though outside maternity care…

This is all quite shocking. I can’t understand how a PA could earn more than a doctor?! Is this at a very junior doctor level only - what kind of disparity are we talking?

Ireolu · 07/07/2023 04:52

GP practices get round this by calling everyone 'clinicians' so you don't know if you are seeing a PA or a doctor. A lot of practices in London are heavily reliant on them because of falling GP numbers and GPs reducing their hours.

I would always ask because there are definite gaps in their knowledge and this horrible story proves that they don't always practice safely or with the required supervision of a doctor. Poor girl and her poor family.

Handholdplease85 · 07/07/2023 05:11

Our GPS have a couple of PAs as well as a couple of paramedics who run a minor illness clinic. In principle it makes sense but that’s assuming you have very clearly defined boundaries about what symptoms constitute a minor illness. For example one of my DDs gets ear infections a lot and needs antibiotics which is quite straightforward, they check her over and check her ears and then the prescription is signed off by a GP.

However if I want an appointment for anything more complicated then I make sure I specifically ask for a GP and when the receptionist asks why, I make sure I use the buzz words I know will get me an appointment. For myself it’s mentioning things like “to discuss my complex long term medical condition” or for the children it would be things to “to request a referral to a specialist” or “to discuss a potential underlying condition”. At our practice those things do seem to work. I do find it quite worrying that you need to do this to actually see a GP.

Weirdly though if you say “red flag” type words like sudden rash, very high temperature they will either book you in with a PA anyway or advise you to go to A&E. Doctors at my practice seem to be used for discussing long term and more complex medical problems - if you feel acutely unwell then it’s either a minor illness (so a PA) or a major illness in which case you get sent to A&E.

Gingerkittykat · 07/07/2023 07:57

Are ANPs better qualified than physician assistants?

The ANP at my surgery is really good and can prescribe too. he also has a better bedside manner than the GPs!

User10486743 · 07/07/2023 08:08

I saw a nurse practitioner at the surgery for my suspected skin cancer (non melanoma, not on my face) as no doctors appointment available and she took a photo, showed a doctor and I got a 2 week referral to the dermatology clinic, it looks to be a BCC and I have an appointment for its removal. I was pleased with the service I received.

Mischance · 07/07/2023 08:18

I rang for appt and got call back from someone who did not sound on the ball at all and was not asking sensible questions. I asked her if she was a doctor and she said she was a PA. She went on to prescribe me a drug that I knew was incompatible with my current drug regime. I gave up on her and did not pick the drug up.