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…

@knitnerd90 UK Maxfax surgeons dual train as both surgeons and dentists, so sounds the same.

The UK doesn’t really have surgical centres in the same way that the US does, so anything not suitable to be done in office is done in a hospital. I am always surprised by how much US surgeons are willing to do in-office anyway! Hysteroscopies, cystoscopies, OGDs, minor ops etc - you wouldn’t do those in an outpatient clinic in the UK.

Yes, it was quite a change when we moved here, and it's only accelerated! The things they do outpatient now amaze me and tbh I'm not sure it's all for the good to send people home immediately, but that's another issue.

(in some cases it can be a financial conflict as surgery centres may be owned by doctor groups. But that's another discussion.)

There are loads of things done as day cases in UK now too @knitnerd90
It's just they're always done in hospital day case units, not an outpatient centre.

IIRC there were a number of deaths here back in 1990s from people having a general anaesthetic, administered by a qualified anaesthetist, in dental surgeries. The problem was when things went wrong there was a lack of backup.
Since then it's not allowed, has to be in a hospital setting.

PAs cannot prescribe in the UK

@mnitg preach!

@Puzzlepart well I’m a doctor and I’ve worked with lots of PAs who’ve gone straight from uni to PA school with no experience. You cannot possibly compare a biomed degree to medical school etc, they cover certain topics in detail but lack the breadth and clinical focus of subjects such as anatomy. We (doctors) have done rigorous post graduate membership exams for the relevant royal college and so structured post graduate training that in some cases last over a decade. Associate professions do none of that. If it’s so important for us to do these exams and meet high standards during training then why do associates get to skip that? Is it unecessary? I want my care provider to be appropriately trained. I don’t want someone with only a 2 year masters intubating me.

I don’t want someone with only a 2 year masters intubating me.

When it comes down to it most people wouldn't be happy for this for themselves or their loved ones, even those saying how they don't see the issue.

Yes, I know they can't prescribe in the UK, I was using the USA as an example of how PAs can work.

I'm not in clinical work but on the economics and policy side, and I can say this: the USA wound up with so many midlevels (as they're called here) because there aren't enough doctors. That was a policy decision with many hands in it, including government and the AMA. The UK isn't going to train its way out of its doctor shortage anytime soon. The data here says that PAs and NPs provide quality care when used correctly, though there's questions about how much money it really saves. That second part can't be easily translated to a UK context because the USA works largely on a fee for service basis.

This is increasingly true actually, and it’s not just in anaesthetics, it’s in other wards and GPs too

agree I don’t like the idea of this and will ask for a consultant anaesthetist

I’m generally ok with the office or surgery center options. For the most part it’s a perfectly safe option and for a lot of smaller surgical procedures going home as soon as possible is the best option for the patient (better rest, less chance for infection are two reasons).

Surgical centers are no different than hospitals surgery, same facilities, same types of doctors, similar end results (statistically).

For same day surgery I actually prefer them. Less stressful, easier to get in and out, generally a more relaxed atmosphere, more comfortable facilities for those waiting for you.

And yes they are generally cheaper than hospital based surgery.

There are other grades of doctors who are safe administering an anaesthetic and have years and years of experience and a consultant nearby. I’d be happy as a doctor for an anaesthetic doctor who isn’t a consultant to treat me. Not all anaesthetists become consultants. Some stay at staff grade or associate specialist level and are very experienced and skilled.

Well if you have a complication that requires medical care not surgical care e.g. pulmonary embolism, severe infection leading to sepsis, cardiac arrest I’d rather be in a hospital than a surgical centre. Statistically the US healthcare systems has very poor outcomes for the amount of money spent, it’s not something I think we’d ever seek to emulate.

Thanks that’s good to know. Thanks. I’m worried about putting my life into the hands of someone with only two years of experience who hasn’t been to medical school

That’s a risk regardless of the surgery location. So I’m not sure what you’re getting at. Glad you like your system. I’m not trying to change your mind.

I wouldn’t be a fan of waiting years for a simple surgery.

My DH felt his knee ‘go’ about 2 weeks ago. He’s been in PT starting the second day, he’s had his consultation with his orthopedic surgeon last week, his MRI yesterday, and his next appointment with the surgeon is tomorrow. I’m guessing he’ll have surgery within the next 2 weeks (at a surgery center).

If he can get safe and expedient care in a surgical center I’m all for it.

So they are becoming increasingly common in the UK and are used widely in certain centres.
They are meant to be working under direct supervision as I understand, who some centres have local governance which may deviate from this.
I’m not a fan of them so chose to take a consultant job in a trust where they aren’t used and they won’t be in the immediate future. I do have concerns about safety and their regulation.
As we’ve seen with physician associates(PAs) it isn’t always obvious to patients who is looking after them and their exact roles.

So just because your surgery didn't have an AA administering, you think nobody else in the UK does ? Hardly critical thinking 😂

Yes but my point is some complications need immediate intervention. If you’re at a surgical centre you may need transporting urgently to the main hospital. Same as when people have surgery in private centres. My point is some things are time critical emergencies, in which case I wouldn’t be wanting to be dependent upon waiting for an ambulance whereas in a proper hospital the icu, medics etc are in the same building. I’m young and low risk, but when I’ve had surgery I like knowing if I had a cardiac arrest on the table (incredibly rare) that a full medical team (not just the surgeons and your anaethetist) will arrive in minutes. Unlikely complications but not something I’d feel comfortable with.

As someone who does this for a living: you can't take the poor outcomes for US healthcare as a whole and then impute it to specific practices within the US health system. The data is solid on the safety of surgical centres, and not just in the US. Canada has them also.

(Also, part of the reason they are safe is that not all cases can be done in them. If your surgery is too complex or you're high risk, it will be done in hospital. They're also typically located near hospitals and there's clear transfer protocols.)

Gotcha.. it was the inclusion of sepsis in your list that threw me off.

That (needing emergency intervention) is a concern but not as much in the US as I think it would be in your area. Mostly because our ambulance response times are on average 4-6 minutes. I think office procedures are a little riskier, in a surgical center they are very equipped to give that interim care before paramedics would be on-scene.

It’s also likely that if you are someone with co-morbidities and a higher risk profile they wouldn’t choose to offer the alternative sites as options. (Or do the procedure at all). Doing a quick search I didn’t find a lot data, just an article citing anecdotal cases where things went wrong (which I do concede happens). But it’s like anything else, there is risk with any type of surgery. Does having it in a non-hospital setting increase some risks, of course. Could they lower others…probably.

Not that I think you care…just found out the MRI results on my husband…Pinched nerve in back, tear in hip, and worse tear in knee. 🙁 Will know when surgery will be scheduled after appt with surgeon. I’ll still be happy with a quick surgery by a reputable surgeon at a surgery center.

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.

Why aren't they paid what doctors are paid then?
Our doctors aren't even paid enough to begin with. Unfortunately in the UK we tend to bring in roles like this to cost cut by paying lower wages.

So called gp’s can f!&k off, yes I never want you never.

from 9am until 2pm as long as you make your own urinary track; ok stay away from me.