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?

I've come late to this. What the hell is a physicians associate? What qualifications and experience is required before they're awarded the title and where have they come from?

Your post is being discussed on a U.K. doctor subreddit. Amongst doctors in U.K. there’s been significant concern about non-doctors masquerading as doctors despite not having gone to medical school or having sat post-graduate medical exams, due to impacts on patient safety and patients being mislead.

It is illegal for non-doctors to lie and misrepresent their roles as doctors. This needs escalation, because by doing nothing, future patients WILL come to harm.

What you presented to GP with were what we would call “red flag” alarm symptoms - these are symptoms that raise significant concern for conditions including cancer. A medical student still in university would be expected to spot the significance of your symptoms and the urgency of extra investigations and onwards referral.

From probity, honesty, and basic clinical competence points of view, the way you were treated is unacceptable.

It’s important to report this. The U.K. government and long term healthcare plan for staffing means there will be greater numbers of non-doctors filling in doctor roles at an accelerated rate, and without reporting we’ll see more harm.

Jeanie Boulet ❤️

@augustslipped I was strongly considering a PA MSc with my bio degree. The more I read, the more concerns I had about it however, particularly the attitude towards PAs. The NHS should be doing more to explain the roles of PAs and ANPs - a previous PP suggested posters in the waiting areas which I think is a good idea.

It’s a shame because the mature students I know from my degree who are considering PA (but having similar doubts) would make excellent clinicians. They would know their limitations and not mislead people about their role. I think part of the issue is that the NHS hasn’t clearly defined their role. For a start I think it should be Physician Assistant like in the US, or Doctor’s Assistant, and it doesn’t help of course that there’s been so many delays and barriers to formal registration despite PAs desperately wanting this. Also, it’s not the PA’s fault that there aren’t enough doctors to offer them adequate supervision, or that they’re being given patients who clearly should be seen by a GP but there are no GPs available. That’s the real scandal.

But the fact is, GPs and other doctors misdiagnose people all the time. You only have to look at this to get an idea of how rife it is https://www.mpts-uk.org/hearings-and-decisions/medical-practitioners-tribunals but it doesn’t make for a news story in the way a PA getting it wrong currently does.

Complain immediately. First to the practice, than to CQC (https://www.cqc.org.uk/contact-us/how-complain/complain-about-service-or-provider) and lastly to GMC. You can write one document and just send them to different places. Missing red flags like this is outrageous. If you believed this person and did not escalate to see a real doctor you would not be diagnosed for a long time and you know what this means when someone has cancer. Not good news.

You will save someone's else life if you complain. Do it asap.

I’m an NHS doctor - a physician associate is a person who will have a degree in a science-related subject (such as geology, microbiology) but did not get into/apply/finish a degree and masters in medicine. They never sit post-graduate medical college membership exams. They receive a 2 year crash course as a replacement for this.

The theory of PA is to be a “physician’s assistant” with taking bloods, scribing notes, etc. but in U.K. most work at the capacity of a doctor due to staffing issues as per the government’s long term healthcare staffing plan. Obviously among actual doctors this is a significant patient safety concern, but we’re mostly powerless to act against it.

A bio degree followed by a two-year full time masters in physician associate studies, which is an intensive course that takes place in a medical school.

Complaining to the GMC about a PA is a waste of time and energy as PAs are not regulated by the GMC, or by anyone, at present.

The GMC should investigate if they're passing themselves as registered medical practitioners.

Thank you @TokyoStories , sounds like a recipe for disaster unless properly supervised and regulated. Very unsatisfactory. Best wishes to OP, hope your recovery soon under way.

As others have said, PAs don't have registration with the GMC or anyone else.

The BMA is opposed to PAs being registered with the GMC i.e. the same body that doctors are registered with, as it continues to blur the role and contributes to confusion.

Doctors are not universally comfortable with the whole situation.

The Emily Chesterton case (which should have a straight forward diagnosis of DVT leading to pulmonary embolism) highlighted how easy it is for supervision to fail when it is not clearly defined.

Going with P Associate rather the P Assistant (from the US) is problematic as it suggests independent practice and misleads. Everyone knows what Assistant means.

And junior doctors (our future consultants) seem to find themselves given the menial tasks that PAs don't want, which impacts on their training and creates a crisis down the road when we don't have adequately trained Consultants.

There are conmen, fantasists, ill people and others who attempt to pass themselves as registered medical practitioners. The GMC have no role in investigating this, the most they can do is confirm whether or not someone is a registered medical practitioner. Their remit ceases if the person is not. It is then potentially a matter for a different regulatory body, the criminal justice system or elsewhere.

Definitely complain - regardless of their title they should have been suitably qualified to see you based on your symptoms and concern, which they weren't having missed a bloody obvious massive red flag.

It'd be clear to me someone saying they were "one of the medics" isn't a doctor, otherwise they'd have said they were a doctor

I wouldn't complain about the fact he is a medic , but that he was dismissive of red flag symptoms .

Yes I would absolutely complain. This was a serious miscalculation.

If your average layperson knows that unexplained weight loss can indicate something serious, then I would expect both a PA and the receptionist to have made sure you saw a GP urgently.

Sorry to hear of your diagnosis, I hope you are now receiving the treatment you need.

It’s important to complain in cases like yours. Thankfully you were able to advocate for yourself but not everyone does. The fact your GP was so quick to react shows the incompetence of the PA.

My GP surgery trains student doctors. Everyone I have seen has been really thorough, at every appointment they have liaised with or brought one of the GPs into the appointment. They have had more training than a PA but have far closer supervision.

Please do complain. There is growing unease amongst the medical community about how PA roles are being used. Advance practitioners (I am one) are regulated experienced staff( 30 years in my case) with very limited roles in specialist areas and alot of additional regulated training. I always ensure I explain I'm not a doctor but work in my case as an advanced practice physio, who can prescribe , diagnose ect. BUT if I see red flag ( ie your weight loss) I know what to do.

PAs have had less training than an Fy1- the most junior, and most supervised of doctors, unable to work outside an approved setting.

The government thinks the plebs won't notice they're replacing doctors with novices.

Definitely complain however medic is a legitimate term for anyone working in medicine and not just for doctors, so I'd leave that bit out.

I am sorry to hear about your diagnosis and wish you all the best for the treatment.
If you can find the strength to do so, you should definitely complain.
You were misled - (twice) - you were told you had an appointment with an emergency "doctor" and then the PA introduced himself as "one of the medics" which is also misleading.
He was dismissive but fortunately you were not convinced and asked to see another doctor who referred you immediately.
Someone else might not have been as on the ball and you and gone home thinking they had overreacted and tried not to worry. That could have meant that weeks went by before they decided to "bother" the doctor again and any delay with things like kidney cancer is critical.
These PAs are dangerous in my opinion. The more people who complain, the better. It's just not acceptable. They don't have the knowledge and training to identify when something is serious and needs an immediate referral.

That other scenario didnt' happen though, I mean you didn't just leave.

What was the timeline, how long ago did you see the PA and when did you get your diagnosis?

Yes definitely complain.
I'm an HCA- I would never let someone believe I'm a registered nurse even though I used to be one.
I'm not even sure what a physician associate is!!! But I'm glad you saw a proper dr in the end, I hope your treatment for your cancer goes well.

I'm so sorry for your diagnosis. The good news is the delay of only a few days between seeing the doctor who diagnosed you shouldn't impact shouldn't put you at any more risk.

I would definitely complain about his dismissive attitude and lack of referral - although I wouldn't get worked up about him calling self a medic. He is a medic. My NHS App linked to my surgery always displays the title of whoever I am seeing.

A PA correctly referred me for am urgent skin cancer diagnosis and dealt with my brilliantly so I wouldn't tar all of them with the same brush.

I am very sorry to hear about your experience and your diagnosis.

Re your question, I would have made that assumption in the past, but nowadays our GP surgery seems to be mainly staffed by non doctors - nurse practitioners and paramedic practitioners. But they should all introduce themselves with their actual title, so I would complain.

Medic has never meant doctor and applies to other job roles so I wouldn’t have presumed they were a doctor. I’m not sure I’ve ever heard a doctor introduce themselves as a medic. I’m also not always aware of the profession of the person seeing me but I do expect them to be competent. Did you say anything to the doctor who saw you to follow up? If not I would 100% highlight it to the practice to review the advice given. Did the first person tell you to go back if not better?

So sorry to read this, hope you get your treatment asap. I'm shocked to hear of this, as others have said already, not good at all! I wonder who they are registered with? It's not the HCPC I don't think? Is it the GMC does anyone know? Are they even registered? If they are then it should be easy to raise a complaint about this. It's not going to help you however, it may well help someone else, wishing you well with your treatment ❤️