Who do you want doing your surgery?

[truth3838383]

Dear General Public,

If I told you that unregulated healthcare workers - who aren’t doctors and nurses, and with no formal surgical training pathway - were performing SURGICAL procedures on you in the NHS

How would you feel? Reasonable? Unreasonable?

(Cystoscopy is keyhole into the bladder up the urethra)

For context: it takes 6 years of university, a minimum of 2-4 years of working and a very difficult and expensive exam with multiple courses to even just be admitted into THE START of surgical training as a doctor

Then a further minimum of 6 years, but usually longer to finish

A PA is a ‘physicians associate’ which do a 2 year course at university that is not medicine

They were originally named ‘physicians assistants’ but objected to the term. Hence associates. You can see what the INTENTION was

Does the intention seem to have been misused to you?

This is happening in YOUR NHS now

This government is wilfully diluting expertise and extremely high expectations and levels of training

And the people on the receiving end are patients

Patients need to know

I couldn't give a stuff as long as they've done it a few times before.

I wouldn't want a Dr doing my blood tests I'd want a phlebotomist. One has a decade of training, the other significantly less.

As long as the person carrying out the procedure was fully and appropriately trained Id rather have the person who does the procedure as their day job do it, not the person with the bigger list of qualifications.

I definitely wouldn't want a PA doing surgical procedures on me - it's a cost cutting measure that puts patients at risk. Ever since I heard about this, I've made sure to find out the job title of whomever I'm seeing in a medical context. PAs don't have proper medical training like doctors and nurses, they should not be prescribing medicines or making diagnoses.

Is this similar to an approach that has been used for some time in developing countries - where, for example , a person is trained in one basic procedure, for example cataract OPs, and that is the only thing that person ever does?

I think if the training were robust enough, and the procedures were simple, local anaesthetic only, I could be ok with that, as long as a fully trained specialist Dr was reviewing the results, and overseeing the ‘quality’. I don’t think it in any way belittles the role of the fully trained surgeon, I do think it can be a practical solution to skills shortages.

Ultimately everyone will want someone with 700 years of experience to operate on them - no one wants to be someone’s first patient. But if they’re qualified and have the right training, it’s fine - even if it’s an expedited course.

I’m a nurse and I would definitely want a doctor to do such a procedure.
Don’t even get me started on the new anaesthetic pathway.
I’m an experienced ICU nurse with a degree in critical care and even I wouldn’t be able to cover anything near what even a very junior anaesthetist knows in two years.

Taking this example and my phlebotomy example. Why is it ok to outsource one invasive medical procedure (blood tests) but not others? I'm genuinely curious.

Isn’t the rule for surgeons training ‘watch one, do one, teach one’?

So even if a surgeon is doing your op, their entire previous experience could be watching someone else do it. And their next op will be teaching someone else to do it?

If a PA is trained to do this procedure, has suitable on-call back up for any irregularities and a proper nursing team for post-operative care, I don’t have a big issue with it

I was reading a while ago about a charity that repairs obstetric fistulas for women in Eithiopia, and the reason they’ve been so successful is that they’ve trained ordinary women how to do the repair surgery

So instead of women suffering for years with the condition until a surgery spot is available, they used trained - but non medical - people to
do the corrective surgery with a normal nursing team to help

I know there should be a big difference in standards of healthcare between health care in rural eithiopia and the UK, but I don’t think it’s automatically a reckless thing to use PA

I think there needs to be very clear indication of the role and the titling of PAs. I note on the information sheets that the PA is titled Mr, which is traditionally the title ( as is Miss, Ms, and Mrs) used in hospitals to indicate a consultant level surgeon. To title a PA as Mr is blurring the edges. There needs to be a recognised and specific title given to PAs which is consistent across the NHS and which could not under any circumstance be confused with another role.

I don't have an issue with it as long as they are suitably trained. But I do have an issue with the fact that these practitioners are unregulated. They are not accountable and can't be struck off a register in the way a doctor or nurse or many other professions can be. I understand that they will eventually be regulated by the GMC but it's madness that this hasn't happened before the role was created

@LonlinessPandemix because phlebotomy is a relatively simple skill with only a few possible complications. I’m not saying it’s not valuable or training isn’t important but surgery or anaesthesia are a different story.
with those procedures it’s not how you cope in the routine cases, but in emergency situations when all the years of training and experience kick in.

Because doing something wrong taking bloods (phlebotomy) is not likely to kill you........anaesthetics on the otherhand😱
I work with PAs and whilst they appear quite knowledgeable they are nowhere near as skilled as a doctor and yet a lot of the patients think they are doctors and call them such. The PA'S do not rectify this and I find this unethical.
I would not have a problem with them doing certain procedures, such as a cystoscopy, if fully trained but I feel that patients should have informed consent for this and not be led to presume that they are fully qualified doctors.

I’m not referring to phlebotomy I’m referring to a wide variety of complex surgeries

But it's the same principle. Phlebotomists aren't doctors, or nurses, they get basic training on how to carry out one medical procedure which they do multiple times a day every day for their entire career. Why is this any different?

A PP said doctors have years of experience to fall back on. All that tells me is to never let a student medic near me again.