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 would, yes.

Even if not currently regulated by the GMC they appear to have misrepresented themselves as a Dr, so the GMC will be interested.

This needs externally reporting if you have the energy OP.

You need to complain to the practice as a first step, but I would also complain to the Medical Director at the local ICB (intermediate care board) or equivalent and to CQC.

Wishing you the best of health OP.

Appalling practice. I'm sorry to know you have been diagnosed but hopefully it is early stages and can be resolved. My DH experienced exactly the same and was referred same day for a CT scan ( not in UK )
He is booked for a partial nephrectomy shortly but the specialist reassured that this type of tumour is usually slow to progress and hoping surgery only, will be sufficient. DH is undergoing 'robotic' Da Vinci surgery... again not in UK but gather it is done the same ..

As for the Physician Associate - definitely complain. He should have announced very clearly that he is not a trained GP.. alot of them I gather are Paramedics? May be wrong ... but the very least he should have done would be to ask a GP for their opinion ON the day whilst you are still sitting there... NO one should ever ignore or dismiss unexplained weight loss... and the advice you received amounts to gross misconduct/dangerous practice. It will become the norm if you don't report it and the way the NHS provision is going, these untrained people masquerading as GP's will cause many serious outcomes if not brought to account. All the best to you and hope everything goes smoothly for you

Yes complain.
2 reasons:

1. they didn’t introduce themselves clearly enough which led you to believe they are a doctor & have the training of one. They do not.
2. they were dismissive of your problem & as a result many patients would have trusted them and ignored their symptoms. This could have led to a later diagnosis and worse prognosis.

I am a doctor & i would expect someone to complain about me if i misled them about my job or if i provided sub par treatment. Personally i think ANP/PAs are dangerous. They have a fairly superficial knowledge of medicine & generally work in a very protocol driven way meaning they struggle to recognise when a problem doesn’t fit the protocol they work to.

You had a red flag symptom which warranted further investigation & they missed this. Your complaint seeks to ensure they don’t make this mistake again in the future.

i hope your treatment goes well & always always ask to see a Dr instead.

Absolutely make a complaint, I find PAs very dismissive of patients in general. I had an awful experience with one a few days ago.

I would find your local health advocacy service ( its free ) to help make your complaint x

You should totally report this case.

I think the physician associate role was created by the government in order to save money, but it is clearly a false economy. you have to report this so that these glaring issues are recognised used.There is a recent case where a physician associate missed a pulmonary embolus in a young actress. the family thought that the patient had seen a doctor on numerous occasions, but it came out of the coroners court that she’d only ever been seen by a physician associate. The PA had never discussed the case with their supervising doctor. The PA was negligent and totally misdiagnosed and mismanaged the patient who then subsequently died. What happened to this physician associate - well she continues to work in the NHS.

physician associate role was
created by the government to save money, but it is clearly a false economy. Please report so that these errors are recognised.

the PAs gave a massive inferiority complex with most being unsuccessful wannabe doctors who couldn’t get into medical school

You must report. A simple letter or email will suffice so you can get on with getting better.

But he may have skipped other people's symptoms that are important too.

Wishing you well.

This is what happens when you allow unregukated clinicians pretend to be doctors, currently being encouraged by the government and some very short sighted medical leaders.

If it was a doctor making the same mistake, you could complain to a whole host of people all the way up to the GMC, as it is you can only complain to their employer I believe.

I'm really sorry to hear about your diagnosis. Hope they've caught it early. I wish you well for the next few months

As a doctor (paediatrics), I'm aware of the regulations. By law it is illegal in the UK to claim to be/ infer you are a medical doctor in a medical context unless you are one. That rule exists to protect the public. A complaint/ feedback protects the next person who may be in a similar situation.

Don't be afraid to voice your experience. At the least, it provides feedback for the service in question.

I think, if you've been told you're seeing a doctor, then "I'm one of the medics" would lead someone to assume they're seeing a doctor. If they gave their full title and people didn't understand, then people can ask further questions. In GP surgeries, they'll be seeing people from other countries, or who don't speak English as a first language, as well, who may interpret "medic" differently.

Obviously the key issue is that he missed symptoms, but I agree the confusing introduction doesn't help.

I also think they should be regulated by someone.

I don't think ANPs are the same, because they are regulated AND my understanding is they usually work in a specialised field and are experts in that particular area (e.g. asthma, diabetes) which makes sense. PAs are, as far as I'm aware, generalists- not someone with experience and specific training?

I find it horrifying that someone with a couple of years at uni and no regulation is given more money and more responsibility than a nurse who has done a degree, further training and +++ years training.
Unfortunately the role really seems to attract the Walter Mitty types who fantasise about being a doctor. I know one or two nurses who are so pissed off they are being usurped by pas they are leaving or retraining as a Pa because they won't have a registration to loose.
I actually know a tutor on a Pa course who was forced into it and thinks it is a complete joke... this is the person training them... it doesn't bode well.

And op I am an RN and I know most people would except a "medic" was a doctor.

As a GP I would want this reporting to my practice manager and investigated thank goodness you went back. I hope you make a speedy recovery xxx

Definitely alarming!
From speaking to other people there seem to be two types - the 'Walter Mitty' that you mentioned. And those with healthcare training leaving for better WL-balance like nurses and paramedics.

I've seen loads of these people in prescriber roles though as <HCA> practitioner it makes me wonder why they'd want to retrain as a PA.

This is completely inappropriate. Unexplained weight loss is a complete red flag should have also examined you including feeling kidney area and dipped the urine looking for blood. Would put In a complain to surgery, the local CCG, but would also to the Royal college or physicians and royal college of GP as these people have no regulation at all. Could go to the media too.

Also I think everyone including if a doctor went to see a “medic” they would presume they were seeing a doctor as the terms are interchangeable and no one who works wi the a PA would call a PA medic as they haven’t studied medicine.

PAs are having an impact on doctor training, as procedures that would usually have been done by med students or junior doctors (under supervision) are now being done by PAs, so the actual med students/junior doctors are missing out on teaching and learning, so are qualifying without some of the skills and experiences that would normally be expected.

My d tells me that some of the PAs she's come into contact with (she's a med student) are people who failed to get into med school so did a science degree followed by the PA course - some are very good but others are quite sneery towards the med students, saying that as they're basically the same as an F1/F2 doctor but they're paid better and don't have to do nights and weekends, they're actually the bright ones...

Hi OP, I'm a doctor and created an account in sheer anger of what happened with you. Absolutely report. In all honesty, doctors are sick and tired of PAs as well. So many are trying to disguise themselves as doctors which is illegal. There's actually a campaign among doctors that is slowly gaining traction of advising patients to ask to see a doctor as more and more less qualified people are taking roles away from doctors.

To put things in perspective for you, an FY1 doctor goes through 5-6 years of medical school and will be responsible for patients on their own, prescribing medications, doing on calls/night shifts, etc. They're also licensed and can be held accountable for their actions. They start on £29k.

A PA does a 2 year degree and in the eyes of the NHS is classed as a higher rank to an FY1 despite less experience. As such, they can have their own GP clinic. Despite this, they cannot prescribe and they do no on calls or night work. They have no governing body and so can't lose a licence to practice if they make a big mistake (e.g. the PA who caused a 30 year old to die recently who dismissed a lung clot for anxiety is still technically still allowed to work).

A PA's starting salary is £43k.

This is why doctors are leaving in masses because the NHS is replacing us with unsafe roles. As such, I would implore you to go to the media about this and encourage others to ask for a doctor.

@Elsie256
Hi OP
hope you’re well and all the best in your recovery.

I’m a physician associate in general practice and I agree that they should’ve picked this up straight away as back pain and weight loss is not just a red flag but a red flag on fire.

It should definitely be reported to the practice so they can look into the PA’s conduct as that’s not safe practice at all.

It’s good your natural instinct kicked in and you had a follow up but that shouldn’t need to be the case in the first place and should be picked up first time.

The introduction should clearly by “hi I’m XYZ and I’m physician associate” no acronyms or other terms.

The receptionists also need to be advised that they are booking the patient in with a physician associate. Our practice ensures of this and if a patient prefers to see a GP then they can.

I’m sorry you had to go through this but glad that you were promptly referred down the appropriate pathway. All the best in your recovery!

@ImplodingPeach why has the role of PA been created when there seem to be loads of auxiliary roles already?
My GP practice has nurse practitioners, paramedic prescribers...

I'm baffled as to why yet another role is needed.

@EldenRing4 i think with ANPs and ACPs/ECPs (paramedics) is that they’re coming from a workforce who also need the increased numbers. By having the progression of nurse to ANP and paramedic to ACP/ECP you’re losing a nurse/paramedic from that pool of clinicians.

That's fair enough, but do those professions also have a lack of training places? I suppose they must do, in which case it makes sense. Isn't the issue with lack of doctors not only retention, but also lack of training places?

Firstly OP I am so sorry for what has happened to you and I apologise for the thread in terms of discussion about the issues with PAs that the public don’t know about.
Thank you @ImplodingPeach - you are so right
I was questioned earlier as to whether my F2 doctor daughter was judgemental around PAs after meeting an arrogant one. No, she isn’t but she won’t sign off on x rays and medications just because a PA has seen a patient.
I can only think the govt has introduced this role to save money as there a limit to what PAs can earn.
If doctors were on the agenda for change contract a newly qualified doctor would have to earn above a PA so would earn above £43k, so not £29k that junior doctors start on.
Needless to say my daughter is now doing locums due to such poor pay and going to work in Australia next month. As a band 5 Bank nurse I am earning more per hour than she is which is ridiculous considering the huge responsibility she has.

I don't understsnd the rationale for the PA role when there is already the role of advanced nurse practitioner. An ANP has a 3/4 year undergraduate degree in nursing, years of experience along with doing CPD during their career, then a masters in addition to this. They are also able to prescribe etc which a PA can't. So why are PAs being introduced? Surely it's just doubling up on a role?

It’s not doubling up on ANP. ANP can already do more and with more training and experience.

It is increasing the workload of GPs or other doctors who have to check the PA work.

The govt thought they were being clever by being cheaper.