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?

At my GPs, we have I think they're called Paramedic Practitioners. Something like that. You see them sometimes instead of the GP. So if someone said they were one of the medics, I wouldn't automatically assume Doctor, but maybe that's because I know we don't always see a doctor. I would definitely complain though, especially as he dismissed you.

I hope everything works out for you xx

I agree. I have zero formal medical training and I would be concerned by those symptoms. He is working outside of his competence. That is dangerous. As would a medical doctor who made decisions that they were not qualified to make. I would definitely report him.

I agree. I’ve ended up seeing a pharmacist, nurse or paramedic and it’s been fine. They’ve been totally professional, made it clear who they were and what they could do. I never felt unsafe with them. This situation described by @Elsie256 isn’t ok.

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’m not sure if they’d have said “Hello my name is… and im a PA” most people would know what a PA is. There should be posters explain the role in the waiting room. More awareness of their roles.

some PA’s that I’ve met who have a background of physio & radiography have been good. Some that I’ve met who have the appropriate ‘ology degree pre PA but not necessarily worked in or have a medical background pre PA training are a nightmare. They are the ones we’ve found trying pass themselves off as Dr’s and stamp their feet when they’re called out on it and stopped from doing things they shouldn’t be doing.

OP, I would have sent you out on a two week pathway with those symptoms, and I'm a historian!

I've also had a poor experience with a PA. I asked to see a doctor and wasn't told by the receptionist that this man was a PA (which at that point was a role I had not heard of before). He introduced himself as 'Mr' and when I queried that, said he was a medical student. It was only later that I found out he was a PA.

I presented with sudden onset, severe, take your breath away abdominal pain for which he initially recommended paracetamol and Buscopan. Not surprisingly, I ended up in A&E, who checked me for anything life threatening and referred me back to the surgery to organise an ultrasound. After three weeks, I went for my scan, to be told that he had requested a completely different area to be scanned! The report said everything was in order where they had scanned, but given my symptoms and where they were , they could not rule out bowel cancer. He simply filed the report!

I complained. I was told he would receive 'additional training'.

The problem turned out to be a jammed ilio-caecal valve. A mechanical problem and very easily fixed.

I guess paramedics are medics without being doctors so a nod in the direction of medic being a catch all term for people who different people who work in medicine. I’m not sure if they purposely set out to mislead you but they certainly weren’t clear. In your shoes I might have assumed they were a doctor too.

Either way the PA was clearly incompetent- operating outside their qualification level and you you should raise a complaint.

I hope your treatment plan runs a lot more smoothly and successfully hereon in OP. Thinking of you.

Paramedics are not PAs.

A practice paramedic will have paramedic training, registration, regulation, further training, and know their competence. Physician Associates are dangerous.

A medic is not a doctor. I know someone who was a medic in the army. He was not a doctor.

I work in the nhs. A medic is a type of clinician. There are lots of clinicians and many are not doctors.

He introduced himself correctly. The fact he misdiagnosed is a separate issue.

Try and join any of the various "medics" groups on social media, and say you're not a doctor.

Doctors call themselves medics. Outside the army, medic=doctor. In hospital, "clinician" could mean anything, but "we need a medic" means "get the doctor." Because ultimately, the buck always stops with a doctor. Because doctors are trained.

This clinician was deliberately vague, and impersonating a registered medical practitioner. Which is illegal.

Very sorry to hear this OP, wishing you a good recovery 💐

Absolutelt complain. Imagine what could have happened if you hadn’t insisted on seeing someone else for a second opinion.

I would have thought he was a GP as well - DH works in cancer research and they refer to all of the doctors working with them as medics or clinicians. I.e. seriously qualified and experienced oncologists with PhDs in cancer research working day to day in both research and treating patients.

It would simply never occur to me in the scenario OP described that I wasn't talking to a doctor.

This is shocking stuff. I have huge respect for nurses, paramedics, HCAs etc and know some who have excellent diagnostic skills (including the fabulous HCA who saved my friend's life by insisting he saw the doctor), but these are all roles that require registration and/or regulation and they are all very clear about what they can and can't do.

If someone can get through this "physician associate" training without learning that unexplained weight loss can be a significant concern, the training is, frankly, bollocks.

I'm so sorry this has happened to you, OP, and wish you all the very best.

But her appointment was with a doctor. She should have been made aware that she wasn't going to see one and that he wasn't one.

Until this post I had no idea that there are such a thing as PA's let alone their roles. Back in the 90's part of my training was within various hospitals and I don't remember seeing or hearing about PA's then. Appreciate that things probably have changed.

Oh that is not on. Are surgeries not putting systems in place about how PAs introduce themselves and their role (and the limits of their role) to the public?

Anyone of my vintage who watched ER in the 90s knows exactly what a PA is because there was a main character with a big storyline. But the character always introduced herself as Physician’s Associate and a description of how they work with the doctors but are not doctors. I’m really surprised surgeries who employ them aren’t doing more to limit the risks here.

I always think of her too on these threads

Otherwise I'd probably think it's a role similar to my asthma nurse, for example, but I don't think there is anywhere near the training or regulation.

It still must be done!

Ignore this advice op.

This is what we get with their nonsense money saving schemes making up more and more watery job titles/training instead of just bloody employing more support staff plus doctors!!

Thanks all. Trying to focus on treatment but can’t help but think about that initial interaction and what could’ve happened if I’d walked straight out of the door after seeing this person

As a lay person can I ask what the idea of PAs is? I can see the sense of seeing a nurse or pharmacist with something like a throat infection with the idea that if it doesn't clear it can be escalated to a doctor. But if they can't prescribe what do they do?

So glad your dad was OK @Anothenamechange. My cousin had the opposite happen (from his GP not a PA) and his cancer went undiagnosed until it was too late.

Back in the 70's my dad was having radiotherapy and, for some reason, my mum went to our GP for an update and this twat told her that Dad had about six months left to live that a) was untrue and b) he wouldn't have known anyway. He had a reputation for being an arse but that was really cruel. He also did something horrible to me when I was older. Horrible man is dead now - good!

Yeah complain.

Wow that was really out of order to dismiss your symptoms and when they are so serious. Cancers are time critical conditions too.

Sorry to her about your diagnosis OP.

I was actually considering studying to become a PA this year as I'm a graduate with a degree in Biomedical Science and wanted to move to a patient-facing role in the NHS. I decided against it after hearing a few stories like this, as I knew in my heart I wouldn't feel comfortable seeing patients with the level of training PAs receive. I also wouldn't want to work in a profession with a bad reputation among patients and HCPs.

I have never seen a PA as a patient myself. I've seen paramedic practitioners and nurse practitioners though and have had really positive experiences, particularly with the nurse practitioner at our GP who is really great.

Really excellent post

Nurse here :) Please report them. The government has been pushing PAs as bargain basement doctors. They have a fraction of the training and are being asked to see patients who aren't yet diagnosed. Diagnosis is the hardest part of medicine you need someone with the best training available. PAs know this so deliberately try to hide this from patients. You deserve better! A young woman died recently from a very obvious lung clot that was dismissed as anxiety.