Do you always ask for a doctor ?

[Karenkerr]

Really really scared reading this. How can they let someone with only 2 years of experience anaesthetise people?

do you always check and make sure you’re being seen by a doctor? Think I need to start doing this…

@Karenkerr you can request one 100% but I'd say your chance of encountering one is very minimal.

They should introduce themselves as not an anaesthetist because to be called an anaesthetist you need to do a lot of training (I'm simplifying here but you need to do loads of training and exams, and generally speaking all anaesthetists are consultants because of the training program in the uk)

if you do encounter one then say you're not happy to have them and you want an anaesthetist.

Genuinely though I'd be surprised if they weren't just doing clinics and planning for the surgery though and in that case you'd be seen by anaesthetist before surgery because I'd need to assess ease of access, ease of intubation, any co morbidities, any anxieties, any previous history of x y z, any family history of x y z... this would be done in clinic but best practice and frankly I don't know any clinician who doesn't check this themselves is to check again pre surgery because it's my gmc registration on the line if anything goes tits up and if any questions in clinic haven't been asked .

Don't be nervous.

Tell the clinician you are nervous and they will do their best to help and give you things to calm down

I've recently been a patient and I was an awful patient because I didn't tell them I was in pain and it got worse so don't be like me!

@Medstudent12 that is terrifying.

I've been off work for 6 months with cancer so tbh I could be out of date already. I really wouldn't be comfortable in one looking after my patients, especially if they are like physicians assistants and they see the patients independently and draw up the drugs themselves.

It's my registration on the line at the end of the day if I'm 'mentoring' so I'd be anal and double checking everything.

PAs just make things harder in my experience as they miss things and don't realise

@CoachBeardsJane so sorry to hear that, I hope you’re getting good treatment and will be back on your feet soon. Don’t rush back to work, make sure you’re looking after yourself too x

Thanks so much. You’ve made me feel a lot better !!

really sorry to hear you’ve not been well ☹️ wishing you a speedy recovery ❤️‍🩹

I think the use of associates isn’t without its problems, but it’s 2 years post grad after a relevant undergraduate degree like biomedical science/physiology, sometimes nursing etc, so they have 2 years actual training but they shouldn’t be starting from a base of nothing.

I actually think the whole healthcare professional structure needs rethinking, there are a lot of inefficiencies in the way training takes place which in turn leads to some of the appalling conditions for junior drs etc.

There was a thread on this not so long ago with an anaesthetist pretty much nagging people to ask for someone qualified

USA has had PAs for 50 years and Canada since the '90s. After a decade plus here I know when to ask for a doctor specifically rather than a PA or an NP. If they are used properly it's great. If they're not, well. There is a tendency here to say "provider" and try to smooth over the differences a bit. PAs can prescribe, as can NPs, but PAs always have to be under the formal supervision of a doctor whereas in many states NPs don't. The PA degree is entirely generalist and then they get experience in a particular speciality whereas NPs only ever train for one path.

the USA also has CRNAs (certified registered nurse-anaesthetists). It requires at least 3 years training past a nursing degree, either a masters or professional doctorate depending on when they trained, and is the hardest specialty for nurse practitioners as I understand it. They can't do all forms of anaesthesia and either work alongside doctors in hospital or in outpatient settings. For example I had oral surgery and there was a CRNA in the office so they can offer full sedation.

These 'associates' are a dangerous way of working.

'Empty ward rounds' were what we used to call them, as they didn't have the training to accurately understand what was required. On paper patients had been seen by a 'suitably qualified person' but in reality anyone can write a date, time, and 'continue current plan'

Not to mention the morale issues they cause for actual junior doctors who are being paid less despite much more training, responsibility and worse working conditions.

I would not accept care from a PA.

I would like to point out that this isn't a snobbery about 'oo they're not doctors'- I have worked with some brilliant advanced nursing/clinical practitioners who are more than capable of independently assessing patients and making plans.
It's this PA route that is dangerous and unregulated.

You can ask for someone fully qualified but what when the answer is no? Surely if using AAs is hospital policy they won't just produce an aneathetist because I say I want one. What then? Refuse surgery that I need? I just think resusing AA would get me sent home untreated. i am very worried by this and really want to know as I don't think the NHS just does what the patient demands!

From what I can gather AA are rare and always work with a consultant anaesthetist …so very very supervised. I’d probably be okay with one if there was supervision and an actual anaesthetist on hand as well.

I was browsing jobs today and saw an anaesthetist role for 500k a year here in the US and recalled a doctor friend telling me they are the highest-paid docs over here because their training is so long and their job is so risky. So yes I would want a doc and they should be getting paid more in the UK by the way.

For example I had oral surgery and there was a CRNA in the office so they can offer full sedation.

@knitnerd90 was this at your dentist?
I'm in Scotland and GA for dental work can only be given in a hospital setting. It's not permitted outside hospitals due to lack of back up if things go wrong

They are generally qualified to degree level in another way.
for eg, a qualified nurse with vast critical care or theatre experience, with additional qualifications in that area and then physicians assistant qualifications.
I know and have worked with a few.
They all had 10 years plus working experience within these areas, a degree, additional qualifications within their field and then gone on to do physicians assistant, so not green straight out of school.

More like 5 years plus of study and years of experience.

They are extremely highly respected, work exceedingly hard to get to where they are and are registered practitioners to begin with, with governing bodies to protect the public and themselves.

This thread is very misleading and scaremongering. Clearly no deeper investigation has gone in before posting.

It was at a specialist oral surgeon's. Here it can be given in non hospital settings. I do believe there are different rules for in office versus outpatient surgery centres though. One of my children needed dental work done under sedation, and for that he had to go to a surgery centre. That's also where another one got their tonsils and adenoids out. There's quite a push to do day surgeries out of hospital.

Oral surgeons in the US have quite a lot of additional training -- mine had an MD as well as the dental degree. That may be why they are allowed to do anaesthesia that regular dentists can't do.

neah, the scaremongering doesn't work for me.
https://www.healthcareers.nhs.uk/explore-roles/medical-associate-professions/roles-medical-associate-professions/anaesthesia-associate

@Puzzlepart It sounds like you are describing nurse practitioners (NPs), not physician associates (PAs) - very different training paths and capabilities.

Physician associates absolutely are not nurses - completely different professions.

nope. As I say, I’ve worked with and know several, they are either ODP by background or nurses who have chosen to gain the physician’s assistant qualification.
The nurses also had theatre practitioner qualifications as well.
I know lots of ANPs too.

You're mistaken, PAs can do a 2 year post grad straight from their sciences undergraduate degree. They don't need any previous healthcare experience and can well be straight from education, youre getting your not doctors but more or less claim to be roles mixed up. It's all good though, if you're genuinely happy for yourself or loved ones to be treated by someone with lesser qualifications, lesser on the job training, less understanding of aspects of the body that help in emergencies should something go wrong, don't have the same knowledge of medicines and how they work then that means more doctors for the rest of us.

Here the doctors wear lanyards which say DOCTOR and introduce themselves as such on first interaction with a patient.

You are mistaken though, PAs changed to Physican Associates from assistances a while ago, and no they aren't nurses who have undertaken additional training; they are science grads who have done a 2 year course. ANPs are different.

You are mistaken though, PAs changed to Physican Associates from assistances a while ago, and no they aren't nurses who have undertaken additional training; they are science grads who have done a 2 year course. ANPs are different.

Yes a PP getting confused between PA's and ANP/ACP.
I guess in theory a nurse could become a PA, but would make more sense for them to go the ANP route.

ANP/ACP = clinical background, are regulated = usually good

PA = non medical background and unregulated = bad

Kind of proves a point doesn't it that it is confusing when it shouldn't be! Interestingly one of my colleagues (I am a nurse) applied for a PA course and was told their degree wasn't acceptable. I'm not sure if this is standard, the stance of one university or whatever but it was interesting. It's also ludicrous that PAs are paid more than junior doctors for a number of years despite a lessee qualification and less responsibility plus better work life balance.

Before I became a nurse though ill be honest I've always respected doctors and known that the degree is hard etc but I was ignorant to the sheer amount of training, knowledge and responsibility they have. No other roles compare in that regard even though we are all important, all work hard and all play a role (albeit these newish roles need defining and regulating). I'd choose a doctor any day, I wouldn't be as worried I don't think if I didn't know just how much more highly trained doctors are. It's the flatten the hierarchy crap gone too far; I agree that everyone should be treated the same as a person regardless of role so flat in that sense, but in terms of role hierarchy doctors should be at the top yet its seen as elitist and whatever to speak this truth.

All dentists here can give RA and IV sedation providing they have undertaken sedation training , have a nurse who has undertaken sedation training, undergo annual retraining , have advanced life saving training and the practice is equipped with the right equipment eg scavenger system for RA and the oximeter, reversal drugs etc in addition to normal emergency equipment and drugs.
You have not been allowed to have a dental GA outside a hospital setting since 2001 but even before then it was an anaesthetist giving it. I was trained in the 80s to give GA but the understanding was a dentist would never do it.
Oral surgeons in the U.K. are doubly qualified doctors and dentists with additional post graduate training.

Yes, as I said, there was an anaesthetist as well as the surgeon, but it was a CRNA rather than an MD. I do know British oral surgeons are also highly qualified but as I don't think I've seen one in 20 years I couldn't remember how they are trained. The last time I saw one in the UK, which was for a cracked wisdom tooth, they were able to sedate me but not as deeply as I was this most recent time. That said, I'm not a doctor, so my level of knowledge of anaesthesia isn't enough to tell you exactly what they can or can't do. It may qualify as a level of sedation that isn't technically GA.

But, the regular paediatric dentist could not do that in the office, which was the other half of it.