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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Physician associate… should I report? Yes or no?

355 replies

Elsie256 · 11/08/2023 23:04

phoned my GP to book an appointment, was told by reception I’d be seen by the emergency doctor covering.

i’ve really been struggling with really back pain and weight loss and was so grateful to have gotten an appointment. Arrived at the surgery and was called into the room and the guy introduces himself as ‘one of the medics’ , I go onto tell him my symptoms and he was very dismissive, told me I was probably overreacting and that I need not worry.

I felt something wasn’t right in how dismissive they were so I asked if I could see someone else at reception before I left the surgery.

the receptionist said ‘well if you’re still worried I can book you in with a doctor in a few days’. Turns out I’d seen a physician associate but they’d just introduced themselves as ‘one of the medics’ so I thought that meant doctor

finally got to see a doctor a few days later who looked very worried and referred me onwards straight away and very sadly been diagnosed with kidney cancer

I’m really upset about this initial visit to the GP and felt I was really misled especially as they didn’t properly introduce themselves and clearly didn’t have the appropriate clinical experience to recognise my symptoms were something more serious. should I be complaining?

OP posts:
TVstolemyevenings · 13/08/2023 22:47

This reply has been deleted

Message deleted by MNHQ. Here's a link to our Talk Guidelines.

Swisschris · 13/08/2023 23:15

Thank goodness you had the foresight to see a Doctor.

Hope all goes well with you.

Juniordoc · 13/08/2023 23:59

You should definitely report. Unfortunately this is the issue with the NHS. These physician's associates are NOT doctors. They are NOT safe to see patients independently. The government want you to believe they can perform the same role as a doctor and aim to plug doctor gaps with PAs. The government is struggling to retain doctors due to poor working conditions and pay and instead of addressing the doctor retention crisis, they are 'patching' with physicians associates.

Please please, always ask for a DOCTOR when visiting the hospital or GP practice. This is what you deserve. Please spread this message to your friends and loved ones as well to keep them safe.

OP sending my love and best wishes for your speedy treatment and recovery. You should definitely complain against the GP practice. You were misled into thinking you were seeing a doctor and instead they booked you in with a PA. I'm glad you trusted your gut instinct.

Nojb · 14/08/2023 03:19

When I worked with PAs in hospital we called them 'empty ward rounds'.

'Name.
Date, time.
Patient well.
Continue plan as above'

Technically the requirement for a review has been met 🫠 but what a waste of everyone's time

Mothership4two · 14/08/2023 04:03

I saw similar during my SLT training @Nojb. There was a term that clinicians used that I cannot now remember, something like "client progressing as expected" that was code for I haven't seen them recently but am ticking the box to not hold the reviews up.

Toomuchtrouble4me · 14/08/2023 04:47

Shortkiwi · 11/08/2023 23:34

My F2 doctor daughter works with PAs - one told her on a ward round that he was basically the same as her. They don’t prescribe or order x rays, work social hours and haven’t got the extensive medical knowledge/training that doctors have. I just don’t get why they get paid a lot more than F 1/2 doctors who have far more responsibility, it’s just not fair. If they ask my DD to prescribe or order x rays she has to examine a patient from scratch as it’s her job on the line and she won’t do it without seeing the patient.

I’ve had prescriptions by a PA. I think there is a valid place for them, fir my symptoms and treatment I didn’t need a doctor but I did need a few tests and a prescription. The PA introduced himself and his correctly and I often ask for him for any known or minor ailments that need a prescription.
I don’t know about pay and I don’t know what F1’s and 2’s are. However I do understand the irritation of thinking they are doing the same job - My gripe is teaching assistants who think they are the same as a teacher - despite having far less knowledge, training or responsibility. It’s a similar thing and must be infuriating for doctors who have trained for so long and so hard to get there.

Rollonsept · 14/08/2023 04:50

FourTeaFallOut · 12/08/2023 07:25

I wouldn't necessarily assume medic meant doctor out in the wild. But if I asked for a drs appointment and was told one had been scheduled and then I turned up and medical practitioner introduced themselves as a medic then I'd assume it was a turn of phrase and was still the doctor from the doctors appointment that I booked.

I think the problem starts right from here on the phone. Patients are phoning for a DOCTORS appointment you don't expect to see a nurse nor a PA. I think the fact that PA are working lone in GP practices is the real issue. Even in hospitals there are too many fancy job roles which are unessacary and are ultimately formed to save money!

Rollonsept · 14/08/2023 05:15

JenniferBarkley · 12/08/2023 12:18

Usually I'm all for strict definitions, but this thread has shown that many laypeople would have interpreted that as saying they were a doctor, so I do think it's relevant.

Posters are right if you look it up on Google OPs complaint won't really hold much weight focusing on the term medic. It doesn't mean solely doctor its a generic term for many roles. It's obviously causing confusion as people on MN don't actually know the correct definition of "medic".

Bliss1221 · 14/08/2023 05:50

Definately report l and demand new app on the day when you call up. A lot of GP surgeries seem to be now palming off as much as possible to the nurses which is such a waste of time to the patient,nurse cant prescribe anything or make a referral

Toomuchtrouble4me · 14/08/2023 05:53

lunar1 · 12/08/2023 09:03

PA's should have no role in healthcare and neither me nor any of mine will ever be seen by one.

They aren't on par with any qualified and registered doctor or nurse. Seeing people think they are senior to nurses is very worrying.

Nurses are professionally registered, have a code of conduct and very clearly defined roles and responsibilities. We don't pretend to be something we aren't. We know when to escalate and get medical intervention from a doctor and work within a multidisciplinary team.

People are being pedantic about the term medic. A layperson would probably assume doctor, a healthcare professional would probably assume someone pretending to be a doctor.

On the future a PA may have a genuine and safe role, where they know their limits. For now it's just dangerous cost cutting.

The sad thing is, many of them probably don't understand how dangerous they are.

I don’t agree.
PA’s can be valuable in taking the weight from GP’s for mundane stuff - for my family they have competently handled ear infections, asthma checks, eczema flare ups, sinus issues and they do seem to have the time to talk when needed.
so long as you know what you’re getting and they are competent enough to refer any concerns then they have a valuable place in giving GP’s more time for the complex or serious issues.

Clearly Op has been let down by her PA. It’s the incompetence that’s the issue, not the role.

It was definitely a doctor, her own GP, who fobbed my mum off for many months with omeprazole, paracetamol and movicom before I got her privately scanned and diagnosed - by which time her ovarian cancer was stage 3/4.

Thank goodness that Op was pro-active, my mother just accepted being fobbed off because doctor said so.

I hope the treatment goes well op, I must say that once diagnosed the NHS have been outstanding with mum and she’s doing really well, 2years post diagnosis, finished Chemo and on maintenance, pain free and living her best life at 91.

Bliss1221 · 14/08/2023 05:53

ClaudiasWinkleMan · 13/08/2023 19:02

You must complain. This is cost cutting exercises and desperate measures to try to plug the enormous gaps in NHS. Unfortunately it’s these experiences that shows corner cutting isn’t productive. And could lead to very poor outcomes. Someone else might think, well the dr is concerned so I’ll just struggle on. Things won’t change if we don’t complain.
But most importantly I wish you well on your treatment and hope you get a lot of support and make a full recovery.

You are so right especially elderly people i know,try to brush everything off as old age problems and eventually when you wouod get then to the gps and if seen by a nurse that dismisses everything they wouldnt go back again thinking they are wasting someones time.

off · 14/08/2023 06:04

Rollonsept · 14/08/2023 05:15

Posters are right if you look it up on Google OPs complaint won't really hold much weight focusing on the term medic. It doesn't mean solely doctor its a generic term for many roles. It's obviously causing confusion as people on MN don't actually know the correct definition of "medic".

For the most part, the way human language works is that the true meaning of a word is whatever people think it means and what they use it to mean, taking into account the environment, the context, and so on.

As a society, though, we've also developed layers of legally-defined or otherwise officially described language and formalised technical definitions, which makes administration and enforcement easier because you can always come back to an official piece of paper somewhere and see what it says.

When it comes to making complaints and doling out disciplinary or regulatory sanctions, you're probably right that the latter system of definition would be heavily relied upon in determining whether this PA could be shown to have been deliberately deceptive, by referring to himself as "one of the medics".

But not only have many ordinary members of the public like me said on this thread that, in the context of a GP surgery appointment with someone they were told was the emergency doctor, they'd think "one of the medics" meant "a doctor", but as far as I can remember, every poster on this thread who's identified themselves as working in healthcare in the NHS, including doctors, has said that in a UK civilian healthcare context, staff pretty much exclusively use "medic" to mean "doctor". This is many decades of combined experience speaking, demonstrating that regardless of any formal definitions, and regardless of what the word means elsewhere or what comes up on Google, in an NHS healthcare setting the primary real-life natural language meaning of "medic" is "doctor". (And I have a hard time believing that the PA didn't know that, but it's always possible).

Clearly the main cause for concern here is the missed opportunity and false reassurance resulting from the PA's management of the consultation. But part of that dangerous false reassurance comes from the fact OP received the impression that she'd been consulting with a doctor. If most patients, in that context, would have taken "one of the medics" to mean "a doctor", then — no matter how incorrect that interpretation might be when it comes to legal definitions or Google searches — by using those words in that context, the PA was, in practice and however unintentionally, communicating that he was a doctor. That miscommunication needs to be addressed and prevented from happening again. (He shouldn't be using language which misleads even a small percentage of his patients about his exact role, TBH, though I accept that some patients will retain false impressions even despite a staff members best efforts to be clear.)

I assume that the OP is less interested in whether the PA can be subjected to formal disciplinary proceedings for contravening written regulations about specific language, and more interested in preventing other people being misled and being falsely reassured in this way with potentially even more serious consequences. In that case, mentioning in her complaint how the PA's choice of language (in combination with the language of the person booking her in) left her with the impression the PA was a doctor, and therefore gave her a falsely elevated level of confidence in that false reassurance, is important to include in her complaint, IMO.

crew2022 · 14/08/2023 06:08

Sorry about your diagnosis.

Absolutely put in a complaint. You were assertive and persistent but the next person might not be.

As someone else suggested, raise it also with the CQC (Care Quality Commission) because although they don't regulate individuals they do regulate GP providers. If they get a theme of complaints about PAs then they also have a voice to increase awareness.

If someone told me they were a medic I would absolutely think they were a doctor and I have worked in healthcare settings for years.

Good luck with your treatment.

ell32 · 14/08/2023 06:10

I'm SO sorry you had this experience and I'm
So sorry to hear of your diagnosis.

Unexplained weight loss is always a symptom that should be taken seriously especially along with localised pain.

100% complain. This is disgusting. Well done for pushing to see someone else.

The main concern is that it could happen to someone else who might go along with it and this could delay treatment and literally be a matter of life or death. I would report to the GP surgery and CQC directly!

I hope your treatment goes well and you make a good recovery OP.

OhNoItsThePinkyPonk · 14/08/2023 06:46

Rollonsept · 14/08/2023 05:15

Posters are right if you look it up on Google OPs complaint won't really hold much weight focusing on the term medic. It doesn't mean solely doctor its a generic term for many roles. It's obviously causing confusion as people on MN don't actually know the correct definition of "medic".

And that’s the crux, there is no definition of medic. Outside the Armed Forces where it is used entirely legitimately to distinguish vocational but not professionally registered trades and Universities where medical students seem to prefer the term it has no common or professional use in the U.K. I don’t think it’s unreasonable to make the argument that anybody in a patient facing capacity who uses the word is deliberately trying to muddy the waters and give a false impression.
One way around this is to encourage GP surgeries to follow the hospitals’ lead and for everybody to wear a name badge displayed prominently at all times.
And FWIW OP I really am sorry to hear of your trouble and hope you have the treatment you need as soon as possible. I should have said that with my previous post, sorry.

off · 14/08/2023 07:02

Rollonsept · 14/08/2023 04:50

I think the problem starts right from here on the phone. Patients are phoning for a DOCTORS appointment you don't expect to see a nurse nor a PA. I think the fact that PA are working lone in GP practices is the real issue. Even in hospitals there are too many fancy job roles which are unessacary and are ultimately formed to save money!

I can understand the impetus to save money, and if there's some kind of safe way to have each patient who needs an appointment booked in with the least expensive staff member who's able to deal with their problem, then that would be great.

The problem with primary care is that people are going to have problems ranging from "normal part of human anatomy that the patient hasn't previously noticed they have" through minor infections and injuries, ongoing care for ongoing conditions, weird presentations of common diseases and common presentations of weird diseases, up to "disease that looks almost exactly like a common minor ailment but will actually kill the patient before the next episode of EastEnders if they don't get to hospital NOW". I don't have medical training, so I don't actually know whether my problem is one of those things that needs a doctor's eye to see the secret hidden clue that only a doctor would pick up on, because it's fucking secret and hidden and I'm not a doctor.

But that whole "why yes it is completely reasonably to expect you, an untrained person, to be an expert in triage to the extent that you might piss off the person at the pharmacy/A&E dept./OOH clinic/GP appointment/practice nurse appointment if they think you assessed yourself wrongly and made the wrong choice of what care to access" aside, what I think would genuinely help is if I had at least some fucking idea of exactly what kind of thing each type of person in a GP surgery could do.

I don't want to be lied to about who I'm seeing, or manipulated into seeing a different kind of healthcare professional to the one I think I need. I know GP surgeries probably think that there's a big chunk of patients who believe they're "too good" for the nurse or the paramedic or the PA, so they either have to force people to see them instead of the doctor, or deceive people into it. But in reality most of us probably genuinely don't know what the nurse/paramedic/PA/whatever can actually do, and if we had the right information would gladly see those staff members for those things that they can deal with, if we were actually trusted to be able to know that no, actually, the nurse won't be able to deal with this, and it'll just end up being a GP appointment on top of the nurse appointment anyway, which doesn't save anybody anything.

They could put a little potted explanation of which kind of staff member can do what and when they work, and what to ask for, into that fucking five minute long spiel of random irrelevant talking and insistences that my problem can probably be dealt with by going on the NHS website or buying something from a pharmacist, that I have to spend my phone credit on listening to before I can even get on to the bloody queueing service.

Maternityleavelady · 14/08/2023 07:22

I have also had a couple of bad experiences with PAs - misdiagnoses of both myself and DC. I always check now to make sure I am seeing a GP

JenniferBarkley · 14/08/2023 08:05

Someone upthread mentioned PAs running their own clinics. Can I ask as a layperson what that means? I understand doctors, physics, speech therapists etc running their own clinics as well as nurse practitioners. If PAs can't prescribe or diagnose what are they doing in their clinics? Obs and blood tests? Does a doctor review them?

Rollonsept · 14/08/2023 08:12

@off no it shouldnt be patients are seeing the cheapest clinician. What needs to happen is people employ and train the correct people in this case an actual doctor. Look at people's stories eventually a doctor had to be involved so time has been wasted and people have been treated later as a result.

Lots of money is wasted on Locum doctors people often say the pay is eye watering it is. However on a hospital the sheer volumes of patients they are expected to see in a clinic is quote frankly dangerous. They often don't stay long due to the volume of work/poor conditions. There's a lot the public don't realise..

off · 14/08/2023 09:12

Rollonsept it would make no sense to have people unnecessarily seeing more expensive workers or workers whose time is more scarce, if the care could be SAFELY delivered in a way that more efficiently allocates resources. I emphasised the safety aspect in my first paragraph because that's extremely important and that's a truly massive if. But WRT the general principle, it's difficult to run an organisation without wasting large amounts of money, if you routinely allocate tasks to more expensive workers that could be done by less expensive workers. (Though sometimes more complicated task allocation can be expensive too, or the expensive worker might have spare time and it's not worth employing an extra person for a few simpler tasks, or there are reasons you might want one person to do all parts of a larger task including the simpler bits, or you might want to avoid packing your most qualified workers' days with only the most extremely difficult, complex tasks. It's complicated. But generally, you don't use a highly-qualified, highly-experienced, highly-paid staff member for a lot of work that can be done by someone less expensive.)

My second paragraph was discussing why in practice, that's a more complicated issue than it seems in primary care, when the person who has to make the decision as to who to request care from is usually the patient, who generally has no training at all. People often don't know what they don't know, and that includes patients, nurses, PAs, paramedics, pharmacists, GPs, specialists, whoever. It might be easy to confidently say to yourself "This problem can be safely dealt with by a person with a lower level of education, experience and accountability than a GP" when in reality there's a big invisible flashing sign that says "needs a doctor" that only a doctor knows how to read.

But the basic principle of allocating tasks efficiently to workers, so that you don't have unnecessarily costly staff doing tasks that could be done by someone with less training and experience, is a sound one. There's a reason that GP blood samples are usually taken by people who are trained just to take blood samples (and paid commensurately with that lower level of training). The vast majority of the time taking blood samples doesn't require an RN or a GP, it's fairly easy to identify who can safely be sent to the phlebotomist for blood samples, and, importantly, the person who ultimately decides whether it's safe for that procedure to be carried out on a patient by someone who is only trained to take blood samples is the GP, who's qualified to assess that.

Ideally, I very much agree with you that the best thing for primary care in particular, where a patient presents with a previously unassessed problem, is for a GP to assess that presentation. Anything else is less safe. Something that looks minor and routine to a patient, a nurse, a paramedic and a PA may set off klaxons for a GP. I want everyone to be able to have a GP assess their health problem whatever it is, and for other healthcare workers to be used to deliver care only once the doctor has decided that's safe and appropriate (like my annual nurse asthma reviews, my phlebotomist blood draws, or the physio I was referred for when I had a sore leg).

I'm just trying to say that I can see why surgeries would want to try to make the most of the limited, scarce, expensive resource that is GP time. I understand that many surgeries don't seem to be able to handle the need (I hate "demand" in this context, it sounds like patients are trying to grab resources unnecessarily) at the moment, and that they might be trying to find ways to redirect patients who may not require someone with GP-level expertise to other healthcare workers, whose time is less scarce or who are less expensive to employ.

The way some surgeries seem to be trying to do that at the moment is by coercing people into nurse appointments even when the patient knows that it will end up having to go to the doctor anyhow, or deceiving patients into thinking they'll be seeing a doctor when they won't, and other similarly shitty tactics.

As you say, this often only ends up wasting time in the long run anyway, and as the OP's experience shows, is very unsafe.

As I said, my preference would be for a GP to assess first, always, because medical assessment and diagnosis of randoms walking in off the street is extremely difficult, pressured, and dangerous — riven with traps for those who don't know what they're looking for, and pitfalls for people following protocols and flowcharts without the extensive knowledge and experience, and ability to think in certain ways, of the average GP.

But if they absolutely have to funnel any first-contact patients to non-GP practitioners, I would much rather they were completely upfront with patients, telling them exactly what kind of things these other workers are able to confidently deal with, and what their limits are, and let patients themselves choose to see these workers. I think surgeries are treating us all as grabby stuck-up people who demand a doctor regardless, which is why they resort to lying and force. But I think that if they informed us properly about these other healthcare workers and what it might be reasonably safe to go and see them for, it would be no less safe than the force and lying approach, and would result in less waste and duplication.

Coffeewinecake · 14/08/2023 09:27

Toomuchtrouble4me · 14/08/2023 05:53

I don’t agree.
PA’s can be valuable in taking the weight from GP’s for mundane stuff - for my family they have competently handled ear infections, asthma checks, eczema flare ups, sinus issues and they do seem to have the time to talk when needed.
so long as you know what you’re getting and they are competent enough to refer any concerns then they have a valuable place in giving GP’s more time for the complex or serious issues.

Clearly Op has been let down by her PA. It’s the incompetence that’s the issue, not the role.

It was definitely a doctor, her own GP, who fobbed my mum off for many months with omeprazole, paracetamol and movicom before I got her privately scanned and diagnosed - by which time her ovarian cancer was stage 3/4.

Thank goodness that Op was pro-active, my mother just accepted being fobbed off because doctor said so.

I hope the treatment goes well op, I must say that once diagnosed the NHS have been outstanding with mum and she’s doing really well, 2years post diagnosis, finished Chemo and on maintenance, pain free and living her best life at 91.

The problem is they don’t know what they don’t know.
Serious conditions conditions present as minor ailments and even doctors with years of experience can and do get it wrong.
Sinus infections, ear infections, back ache, head ache are so common, over 98% will be minor. The chances of picking up
the 1-2% come from training

Hammy65 · 14/08/2023 10:09

Just a little tag on to this impressive thread - my experience with seeing a nurse practitioner, as they are called at my surgery, was that the lady in question went out to consult the doctor after my examination. The doctor, who I didn’t actually see, suggested a scan referral which the nurse practitioner then instigated. Surely this is how the system is supposed to work?

GoodChat · 14/08/2023 10:10

Hammy65 · 14/08/2023 10:09

Just a little tag on to this impressive thread - my experience with seeing a nurse practitioner, as they are called at my surgery, was that the lady in question went out to consult the doctor after my examination. The doctor, who I didn’t actually see, suggested a scan referral which the nurse practitioner then instigated. Surely this is how the system is supposed to work?

Absolutely. My little one needed antibiotics and the nurse practitioner said she was going to send the prescription to the GP to sign as she can't prescribe and it'd be at the pharmacy within the hour, which it was.

JenniferBarkley · 14/08/2023 10:20

I've had great experiences with nurse practitioners, particularly for asthma, over the years.

Strawfairytart · 14/08/2023 10:24

Nurse practitioners are completely different to physician associates.

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