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?

YANBU definitely complain Its awful they were so dismissive about how you were feeling and not listening as that lead to them not taking correct course of action rather than lack of medical experience.

If I'd booked a doctor's appointment and was told it would be with a duty doctor, I'd not think anything of them saying medic either.

I don't really understand if a PA doesn't have GP experience to diagnose and can't prescribe what would be the point of booking in patient with severe pain/ weightloss, maybe useful for things like reviews for long term conditions.

Complain.

Most people don't know what a physician associate is and would assume 'one of the medics' is a doctor. Even worse you were told you were booked with a doctor.

Doctors are only allowed to work unsupervised in GP if they are a fully qualified GP

However physician associates are not a regulated profession, can do their 2 year course and apparently that's fine

The whole situation is a pending disaster

Absolutely you should report as he blatantly lacks the knowledge of redflag cancer symptoms and this is just not good enough. The cockles is a dangerous attitude also. Was your urine even dipped, it must have had blood in it, was this just ignored?

Anyway I also want to say though, i am an ANP.
I start every single consultation with " Hi I'm insert my name, I'm one of the ANPs". I say this very coherently. I wear a bright red uniform (scotlands national ANP uniform) and the drs wear blue and green scrubs. I always wear a name tag which is large and has my name and ANP on it. I swear at least 95% of my consultations end with the patient standing up and saying " thank you Doctor". I started saying fully "advanced nurse practitioner" this did not reduce the number of patients referring to me as Dr. I often get thank you letters written and they always refer to me as being a dr, which worried me that people will think I misrepresent myself as a dr but my colleagues know I do not do this and have no intrest in such nonsense.
I will say I am a very experienced and thorough ANP who is genuinely very interested in my job and strive to fill my knowledge gaps always, so I do wonder if the assumption that I am a dr comes from the quality of my consultations but I genuinely cannot see how i can make it more obvious to patients.

That was meant to say cockyness not cockles lol.
Sorry for your diagnosis, hoping for you it's been caught early and responds well to treatment xx

Yes please complain. I am sorry about the news you received. However well done for advocating for yourself and getting to the diagnosis.

OP please ignore the posters unhelpfully suggesting that you have missed a name badge/plaque on the door/misunderstood the bizarre term of "medic"

Thank goodness that you had the presence of mind and assertiveness to get a second opinion. Many people would not. Please complain about this dire incompetency.

Firstly, I'm very sorry about your diagnosis, OP.

There are some concerns amongst GPs about the role of physicians associates. They seem to be the government's solution to cheap labour and plugging the gaps in the health crisis. However, unlike GPs, they have not done 5-6 years of medical school and more importantly they do not have post graduate medical training as a junior doctor (all GPs have at least five years rotating through specialties). So things like this are much more likely to happen.

That being said, doctors miss cancer all the time. GPs, A&E doctors, medics, paediatricians surgeons... It's often really hard to diagnose and usually the patient has presented multiple times before someone realises something is very amiss and orders the right investigation.

I would take a few days or weeks before complaining. If you still feel you want to do so, I would start by giving feedback to the practice. Explain that you do not feel he introduced himself adequately and that this misled you to believe he was a doctor. I know some posters have said to report him to the GMC (which may soon be possible) but please know all complaints railroad a healthcare professionals life. The guilt is astronomical, the shame, the worry about the loss of earnings, etc... I have known many good doctors who sink into years of anxiety and depression over complaints, some ultimately walking away in the end.

So while feeding back to the practice, maybe insisting on a meeting with the manager, may be a good idea in this case, I do not think escalating it from the start is the right thing here. But please, take some time to look after yourself first. You've had really shocking news and need to prioritise your mental well-being over everything at this stage.

Yes

YANBU

OP was at her appointment for a covering emergency doctor at her GP surgery. I would have assumed the same. I think he was being deliberately disingenuous and should have said "I am not a doctor".

I have heard doctors in the Forces being called medics

I say this as a Paramedic who works in a GP surgery yes you should definitely absolutely raise a compliant. If I had made such a gross error I would absolutely want to be aware of it to reflect on the error and never make it again. Also there needs to be an opportunity for their employers to consider what happened/could have happened, whether they are safe to continue practising. Fortunately because of your actions it's a near miss but this absolutely needs flagging. Although this should have already occurred following your visit to the actual Doctor - I'm sure it came up you'd been seen by the PA, but they'll have seen the consultation on the system.

It terms of introductions it's probably technically ok since they didn't say they were a Doctor/GP, but not ideal. It's easy for me because Paramedic is a recognisable title/profession but Physician Assistant/Associate is a bit of an unknown to most. I often wear my college of paramedics shirt but still get called Dr, I find it grating as I worry my colleagues could think I'm trying to pass myself off as something I'm not.

If the Surgery is well set up anyone not a qualified GP seeing undifferentiated patients should be debriefing all their patients at the end of the day with one of the GPs, that's what I do at the surgery I work in. This would include ANP/ACPs, PAs, Paramedics and Junior Doctors. the debrief is normally a quick summation so if I say I saw Dave who's 22yrs presenting with a 3 day history of a productive cough seeking antibiotics, he examined well with normal observaions and a clear sounding chest, no risk factors for vte... given viral self care/worsening advice, moving on... but then if it came to your your consultation - Yes I saw Elsie265 who's probably in the age group where cancers start becoming an increased risk and she's complaining of a non-traumatic back pain with unexplained weight loss which she's concerned might be related... I've told her it's likely anxiety and to get some fresh air and didn't arrange any further testing to rule out any other possible cause... It gives an opportunity for the GP to beat me over the head with the keyboard and get you back in ASAP.

Absolutely well done for advocating yourself and getting seen properly, such sadness your concerns were founded but really the short delay extremely unlikely to have a bearing on any outcome, not that this minimises the PA error of course.

YADNBU They should have introduced themselves by their name & role.

I'd have taken medic to mean I'm not a doctor, I'd have assumed nurse practitioner. Clearly they have missed your diagnosis and it's fortunate you pushed further. I'd definitely raise it.

I am so sorry about your diagnosis OP
I definitely wouldn't assume that medic meant doctor. I'd take it to mean someone who works in the general field of medicine. Perhaps this is how he has been told to introduce himself.
This isn't the main issue anyway. That would be his dismissiveness and incompetence.

GP here. Yes I think you should write to the practice. There are a lot of concerns in the GP world about physician’s associates working unsupervised and this needs to be flagged up to the practice- for the PA’s learning and for a warning to the partners that their PA needs more supervision.

Doctors refer to themselves as ‘medics’ all the time- I would have totally thought that he was a doctor. I would say he was deliberately using this term in order to make himself sound like a doctor. Again, if I was employing him I would really want to know. In the tragic case linked to above the fact that the PA did not identify himself as a PA was one of the big factors in the criticism of the employing GPs.

So sorry that you are going through this. Please highlight this to the practice
if you can so they are aware.

Best wishes for your treatment op.

I think the biggest concern is this PA does not have the skills to do the job and this needs to be clearly flagged. This was a terrible near miss. I was triaged at the GP for back pain by a non-medic (they clearly states they were doing triage and not a doctor, a physio by training) and about the third question they asked was if I’d had any I explained weight loss.

I think the introduction as a medic was misleading but I can see that PAs might want a short hand way of introducing themselves. But you were misled and it should be flagged as well.

but in your complaint I would lead with the missing of red flag symptoms.

Please complain. The next person may not feel they can speak up.

I wouldn't have thought he was a doctor if he used the term 'medic' but I think he should have been clear about what his title was. I don't think that's the basis for the complaint, though. I think the fact he dismissed you off hand for what were very clearly symptoms that needed investigation.

I'm sorry to hear about your diagnosis and hope you get well very soon x

Definitely report. That is appalling.

How many other people is he telling that they are overreacting about nothing?

would you have also assumed doctor if someone introduced themselves as ‘one of the medics’?

If someone introduced themselves with their name (rather than Dr) and described themselves as a medic, I would assume they weren't a dr and that they were deliberately obfuscating.

I would definitely complain.

Yes complain. Unexplained weight loss is always a red flag symptom.

This.

A medic is not a Doctor so I don't think you can complain about this aspect

Focus on the fact that they missed your needs and you were dismissed,when you should have been sent to see the GP as soon as your red flag symptoms were noted by the medic.

Another GP here, I came on to say everything @BurntoutGP said but less coherently. I’m really sorry about your diagnosis. If this was my practice the partners would really want to know your side of things I think, including how they introduced themselves. Not following up or investigation new onset weight loss should have been picked up and acted on by the supervising GP if they were debriefed properly. For a PA to introduce themselves as a medic not job role in a GP practice is absolutely wilfully misleading and very concerning. They know how that will be interpreted.

Im so sorry about your diagnosis and well done for pushing again to be seen. I hate how we have to fight to be heard and taken seriously at a time when we aren't feeling our best to have to keep pushing and advocating takes so much mental strength.

I agree with complaining. They need to learn to do better.

@Reallybadidea did you really have to quote the entire first op? Yes we know what the op is, this is what we are all commenting about unless otherwise tagged.

I believe you about the misrepresentation over the phone, too (though I suppose it may have been accidental, and the person booking you in assumed that that surgery was being done by a doctor).

I was sent a text message appointment a couple of weeks ago by my surgery telling me to come in and see the nurse, with the appointment listed as being with a nurse on my NHS app, giving her name. But she turned out to be an HCA.

She was clearly a very experienced HCA and I liked her. She herself didn't describe herself as a nurse (or as anything; she did have HCA on her badge, though), and I didn't want or need a nurse; the HCA was entirely capable of what needed doing in that appointment. And I know that "nurse" isn't a protected title (and that the HCA role used to be taken by people known as Auxiliary Nurses).

Nevertheless I believe it's misleading and wrong to describe it as a nurse appointment, at most people would, I think, interpret that as Registered Nurse, someone with probably degree-level education in healthcare and whose PIN is at stake. And I think most people would probably assume "one of the medics" means a doctor, especially after being told their appointment was with the duty doctor. I'm pretty sure I would've.

GP surgeries seem to have got pretty blasé about being honest with patients about who they're being seen by. I know they're probably trying to head off patients who would insist on seeing a doctor and not a PA/nurse/paramedic, or a nurse and not an HCA, when they're trying to get each patient seen by the person with the minimum expertise necessary for the sake of efficiency, or whatever. But deception is really not on, and your experience shows that they're not building in nearly enough safeguards either.