Physician associate… should I report? Yes or no?

[Elsie256]

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?

@Toomuchtrouble4me
F1 and 2 doctors (or FY1 and FY2 )are foundation doctors. They are newly qualified from medical school after a 5/6 year medical degree and enter a 2 year foundation programme before specialising. My issue is that they have a lot of responsibility from the start. They rotate every 4 months so complete 6 placements in 2 years. They are supposed to be in training but in reality end up being service providers and are often the first port of call if a patient is unwell. They examine, admit, prescribe, take bloods, order x rays, review, write discharge summaries etc. PAs cannot prescribe or order x rays so have to get a doctor to do this which means a junior doctor has to examine the patient themselves as it’s their job on the line.
PAs starting band 7 salary is between £40-45k avge £43k
Doctors -
FY1 - £29, 384
FY2 - £34, 012
I just don’t get it. How has the BMA let this happen? As I stated earlier, if junior doctors were on the agenda for change contracts like nurses and PAs they would have to paid more than them due to their level of responsibility and role. What’s also ironic is if a junior doctor who may have had enough of low pay for high responsibility and unsocial hours cannot apply to become a PA!
I am still thinking of you OP.

"How has the BMA let this happen?"

They haven't. They're striking.

How have the public let this happen?

I meant let junior doctors pay be so badly eroded over the years and are only striking now.

They went on strike over the new contract that eroded pay? The public let the contract be imposed by the government, and voted that government in again?

They went on strike in 2016, and now. I don't think they've let this happen. The government (that the public voted for) have been bullies, driving down pay, conditions, infantilising highly trained, highly skilled people. The BMA is a union, it's made up of doctors, who would rather spend their time with patients than fighting. I don't think they're to blame here.

I suppose because the F1&2 doctors will get steep increases and ultimately spend most of their working life very well remunerated. Where’s PA hit a ceiling pretty early on and stay there.

"very well remunerated" then why are they striking, and moving overseas for better pay and conditions?

This has probably already been asked, so for that I’m sorry - but what’s the difference in a PA and a nurse practitioner that we have at my practice? Bit confused here.

A nurse practitioner will have done their nursing training and then worked clinically for a number of years, usually working their way up through agenda for change bands starting at band 5 on graduation, before joining an MSc programme which is often done part time over a few years while continuing to work clinically. On completion of this they can apply for band 7 nurse practitioner jobs. They continue to be regulated by the nursing regulator and especially in primary care will often have a specialist area that they focus on, with supervision from GPs. For example in my own GP practice there is a nurse practitioner who offers a specialist menopause and womens health clinic. Most ANPs I have worked with are excellent and have a lot of clinical experience under their belt. They know what they don't know. I have yet to meet a nurse practitioner in training with under a decade of clinical experience behind them.

PAs have an undergraduate degree which doesn't have to be patient facing, just scientific, and then two years on the PA degree programme. They then join at Band 7. They do not have a regulatory body and there seems to be massive variation in the way different departments utilise them.

So sorry Elsie that you received this upsetting diagnosis - and for the fact that your concerns weren't initially taken seriously. Thank goodness you had the presence of mind to immediately seek another opinion. Wishing you all the best for your treatment.

Whether medic means doctor or not, the point is many people will perceive it to mean doctor. If you make an appointment at your surgery, you expect to be seen by a doctor, unless you are clearly informed otherwise. In any case, whether seen by a a doctor or some other member of the health team, a patient's concerns should not be so easily dismissed, especially when significant weight loss and pain is being reported.

Someone said the staff will "close ranks". Is there another regulatory body, to which a patient can send a copy of their letter of complaint to the surgery? In my opinion, it is absolutely essential that this incident be reported. The "medic" appears not to have examined the OP or taken the matter seriously. The OP could have accepted what he said and still be none the wiser.

It was in my local paper recently a 28 year old woman saw an associate physician twice in 2 weeks with pain and swelling in her calf. Associate physician dismissed it both times as something minor, muscle sprain or something. Turns out a few hours after, she was rushed into hospital with a DVT and died of a PE. She should have been sent into a&e the first time, but she could have survived the second time. I don't know if there was any other relevant history....given her age she may have been on the Pill.

I'd complain if I was you. Unexplained weight loss is always a red flag.

Beautifully said, imho, Ellyeth.

What troubled me too was that Elsie writes,
"phoned my GP to book an appointment, was told by reception I’d be seen by the emergency doctor covering."
Which tells us she was clearly expecting to see a Doctor.

I think it is the overwhelming consensus that this needs to be reported and redressed. Not only must Patients be asked if they would be willing to see a PA, but be told what one is. Also the PA must make it clear what their status is. Then this one needs retraining. It has been reported here how many near misses or worse have happened by poor diagnoses at the start resulting in a disease getting beyond the stage when satisfactory treatment would lead to a good outcome.

I send my very best wishes to you Elsie, I think you have done a good thing in bringing this to our attention. Your experience might well save many people. Thank you for your common sense and courage. With love, Elle.

Shortkiwi Crikey! Thanks for all that info!! I am aghast! I'm keeping your info to show some friends who go on about Doctors having lots of money... I have two Docs living next door, lovely couple, he has finished his GP qualification and is working as a GP, she took mat breaks and I think is still finishing the f2 bit. I just cannot believe what they've put themselves through! I have long held the NHS is in a mess, even 40 years ago I was in a London hosp as a patient and was shocked at the state of the ward. But how young Docs get through, especially when they might have a bully of a Consultant over them as well.... they must be saints!
As I read your info, I was thinking why don't F2s become PAs? then you dropped the bombshell. Basically it's just sh*t. They are bamboozled all round. Doesn't anyone care what happens to them?
Sorry had to rant. Couldn't get over it. Heaven forbid I need hospital treatment, but if I have to be treated by any young Doc then I'll be extra nice to them (I usually am anyway,) but now I know this... well.... it's slavery!

Thank you @Ellyess
I am frustrated beyond belief. My daughter has recently passed her 2 years as a foundation doctor and is off to Australia next month to work because of the current state of affairs. I am on a basic grade as a bank nurse and earn more than her per hour.

Thank you Scaraben. That’s a brilliant and simple explanation. How did this all happen? Could we all just see a doctor(GP) at our local practice when we need one? Like we used to?? 🤦🏼‍♀️!!

Sorry to hear your diagnosis. But did he maybe say 'one of the clinicians'? That covers a multitude of medical staff at a GP surgery.

She’s already told us what he said. You don’t need to gaslight her.

Well, he’s getting his diagnoses wrong and missing cancer so he’s halfway to being a dr really isn’t he?

...and it certainly puts it into context when the press are implying that the junior doctor strike is because they're greedy/selfish/lazy....

@Shortkiwi if you look at agenda for change criteria FY1 and 2 wouldn’t score that highly because they are supervised. FY1 don’t legally have prescribe rights? A lot of the criteria are non clinical so relate to managing staff etc. I’m amazed PA have got band 7 tbh given other graduate HCP start on band 5 or 6. Band 6 for those with 5+ years of training on qualifying

Of course fy1s prescribe. In some small hospitals, fy2s are the only doctors there overnight/weekend, lead the resus team, staff A&E.

If you attend A&E, you will probably see an fy2.

FY1s can and do prescribe but are ‘pre-registration’ and are technically supposed to have all of their work supervised by a more senior junior doctor.. Doctors don’t gain full registration until FY2.

Correct though realistically most F1 prescriptions are not supervised. F1's on call are usually trawling the wards alone and making many decisions themselves.

Provisional. Not pre.

It's like probation. It's light touch "supervision."

They're doctors, just their registration is provisional on not majorly cocking up in the first year.

PAs have no registration. No one checks if they cock up.

I'm sorry to hear about this experience and subsequent diagnosis OP.
Yes, complain

I posted on this thread early on and said how we recently saw a PA for my daughter and that he was good. We saw him 3 times as the underlying problem wasn't going away. We pushed for a dermatologist referral.

We saw the derm yesterday who said the problem is different to what the PA thought it was and she is now on the (hopefully!) correct treatment.

So the PA misdiagnosed my daughter and we wouldn't have known better if we hadn't pushed for a referral! Grrr