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?

They're not registered or regulated.

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.

Sorry about this OP. Thank you for posting though as I will now ensure none introduces themselves as 'one of the medics' when I am in pain and have gone ti see a doctor. You cannot get another appointment in 2 days but have to wait several days, if you are lucky.

Personally I think it’s a major issue for a HCP to not be required to have a professional registration, although the same applies to paramedics for some time.
they haven’t actually impersonated a doctor though and presumably the GP partners who are invariably doctors were quite comfortable with employing them.
unless the public is willing to stump up a lot more money to train and retain HCP there’s going to be a constant move towards less qualified staff, through new riles
and through less academic learning. Perhaps PA training will be less attractive when people can do an apprenticeship to become a doctor

@Shortkiwi And herein lies the problem. You get bad PAs.... just like you get bad doctors. Sadly, with the massive gap in clinical services the UK introduced PA's (for which you need a Masters Degree in PA having done a BSc in an associated science), the USA is WAY more respectful of the role and I was reading a study the other day how UK clinicians don't understand or respect the PA's role..... sounds like your DD is in that category.
So yes, there's some poor PA's but maybe your DD is rather judgemental of the role. Sure there's probably some PA's helping to hold the fort over this weekend.

I'm not against 'non-doctor' medical staff. There are a lot of routine things they can do.
In some cases they can even be better... an ANP has in-depth specialist expertise in a single subject area and will have seen more than say, a GP.

The problem is that there are too many of them, it's so hard to keep track!

In my current practice you send them questions to be answered with an appt made if necessary. So far I have had a GP, paramedic practitioner, nurse something or other...

Never had a Physician's Associate though!

Any HCP should make their name and full professional title clear. No using vague term like 'medic'.

Yes. But what the hell is a 'physician associate'? How qualified are they?

I'm sorry for your diagnosis and if you've got the energy, definitely complain

Please don’t underestimate nurses for many years the job of the nurse was sometimes to guide the doctor as they spend longer time with the patient they picked up on intuitive things that at times men just do not pick up on. I myself had a professor ask why I needed HRT I had to explain why I needed it. Nurses nowadays are as qualified (all have degrees & some have masters) & are knowledgable as junior doctors not only do they have to know their job but the doctors job too. I myself on many occasions suggested doctors do things or directed them with suggestions or even shouted if I felt it was dangerous. This has always happened this isn’t something new, so for you to say it is happening before our eyes with this is not accurate. lots of things in the NHS are changing now as a patient myself the nurses who are my safe place if I feel I am banging my head against a brick wall.

Working lifeYou’ll be a graduate who has undertaken postgraduate training and you'll work under the supervision of a doctor. You’ll be trained to perform a number of day-to-day tasks including:

• taking medical histories from patients
• performing physical examinations
• diagnosing illnesses
• seeing patients with long-term chronic conditions
• performing diagnostic and therapeutic procedures
• analysing test results
• developing management plans
• provide health promotion and disease prevention advice for patients.

Most physician associates currently work in general practice, acute (internal) medicine and emergency medicine.

Someone needs lots more training!

If a doctor makes a mistake due to PA, that doctor could be struck off. PA cannot be struck off, because they're not on anywhere. Damn right a poor fy2 can't trust them.

Someone with one year's postgraduate training shouldn't be diagnosing anyone

The issue is they did not explain their role to you and they did not diagnose correctly.
A good gp practice will already be aware of these faults and will have already had meetings to discuss you as part of new Cancer diagnosis. They will have discussed your case as a Significant Event in practice with all clinicians (Inc PA) to share learning and practice improvements. They are nit likely aware the PA did not explain their skill level- they should. I'd be concerned the PA does not feel comfortable sharing they are considerably less skilled than a GP - their issue not yours.
If I was you I would ask for the practice manager to call you to discuss - and enquire about the Significant Event Analysis and documentation. You may also request a conversation with your GP to discuss how you are feeling. If after this, you are not satisfied, raise a complaint. You were swift in getting a second opinion- others may not be and have worse outcomes. I work in general practice and there is no way i would not want to do something as a result of your experience. Best wishes for your ongoing care and health.

@Elsie256
A BSc in science - eg - Biomed, followed by 2 years masters degree specifically in Physian's Assoc.

You can do a 4 year undergraduate programme @Bogofftosomewherehot

They are introducing regulating but it won't begin until late next year at the earliest.

www.gmc-uk.org/pa-and-aa-regulation-hub

No one should be providing front line medical care unless they're regulated.

And I really don't think a thread in which a woman is reeling from being diagnosed with cancer when the PA told her to go away and not worry about if is the thread to sing their praises.

@buddy79 - This is very small beans but I have an appt forthcoming to discuss menopause symptoms and HRT and it was offered as an appointment with a nurse - not a doctor - and whilst I think generally nurses have excellent knowledge I am still a bit surprised. NHS is changing before our eyes.

I would rather see a nurse with a masters in sexual health who has worked hard and has the ability to run a menopause clinic rather than an ill informed Dr. My Dr is useless on the meno.... and also missed my women's cancer. Too many people put all their faith in the Dr and should see that other HCP's can be just as good, if not better.

He didn't introduce himself correctly.

As medical students, we are clearly told that we will always need to introduce ourselves with name, role and level of seniority (3rd year student, FY1/2, reg, consultant). In practice I have always seen Drs at least introduce themselves as a doctor. Nurses introduce themselves as a nurse, physio as a physio etc. Patients need to know who they are dealing with. In fact this forms a part of our practical exams and informed consent.

'One of the medics' is vague and possibly obfuscatory.

Not saying it's the key point here but if there are PAs such as the one mentioned upthread who are happy to claim to be equivalent to doctors then that is not safe. ACPs and nurses don't do that and some of them have decades of experience.

It apparently needs addressing during PA training even if some PAs are excellent. All clinicians need to acknowledge and work within their capability limits.

They may be fine in hospitals, where there is a team structure.

Primary care is the most risky specialty. You have undifferentiated, undiagnosed, untriaged patients, from the whole population. The same symptoms could be anxiety... Or deadly. You need highly trained, highly skilled people doing this. You can't do it on the cheap. You can't do it on two years training. GPs have at least three years training AFTER at least five years of medical school, and at least two years postgraduate training. So that's ten years intense training, as a bare minimum. Other registered clinicians will have had similar, and still know their own competence, and will defer/refer to GPs as needed. PAs are not registered clinicians. In primary care supervision has to be light touch, if a doctor supervises everything, then that costs twice. PAs are used because they're cheap, and there are few GPs.

The most dangerous thing about PAs is the lie to themselves that they've done "intense medical school in two years!" They haven't.

OP, I hope you're getting the treatment you need, and you get well soon. Please complain. Patients accepting PAs means the government and the private companies taking over GP practices think they can get away with it.

Doctors wouldn't want themselves or their families seen by PAs. Rishi Sunak will not be seen, or have his family seen by a PA when ill, I'll bet.

@Clymene You might want to check your understanding of my post..... I wasn't singing praises, I was stating a fact and in response to someone else's post, jog on.

PS - @Clymene , you'll also see from my post above that my dr missed my cancer (a few times over).....so I've been in same boat as OP. Like I said you get good and bad PAs and Dr's.

Im Not understanding the PA hate on this thread. The training is thorough with clinical placements and exams. INFO HERE
The GMC will be regulating PAs but are awaiting changes in legislation. This should happen next year. The GMC have already produced interim professional standards for PAs. It's not some made up new profession.

In case anyone hasn't noticed there is a shortage of Doctors and there is a shortage of cash within the NHS. There are areas of a doctors work that can be safely delegated to someone who isn't an actual doctor. They would be supervised, monitored and assessed obviously.

There are lots of routine operations such as carpel tunnel OPs that could be delegated to a PA rather than tying up a Doctor. There is a huge focus on saftey and

@Strawfairytart
The most dangerous thing about PAs is the lie to themselves that they've done "intense medical school in two years!" They haven't

Blimey how many do you know and how strange that they all think this 🤔

I work in healthcare.

I didn't say all. Generally, I'd say there is a physical (chromosomal) difference between those who are aware of their limits, and those who think they've done medschool in 2 years. In general. NAMALT and all that. NAMPAALT.

Introducing themselves as “one of the medics” was purposely misleading. In a professional environment they should be making it clear exactly who they are. I assume they do this as a lot of patients would prefer to see a doctor. That’s the first issue.

Then you’ve got the fact that they have been unable to spot warning signs of cancer (competency issue) and their dismissive attitude.

I think you should go back on all of these issues. This person is a liability.

I’m sorry to hear about your diagnosis. Wishing you luck.

Please report it directly to the ombudsman. You are not being unreasonable. They need to be properly regulated.