Columnist Dr Copperfield says tragedies are bound to happen more often when general practice is fronted by ‘non-doctors’, such as physician associates, rather than GPs
Let’s be 100% clear. I am absolutely not, for all sorts of obvious reasons, commenting specifically on the tragic case of a patient allegedly misdiagnosed by a physician associate (PA).
And to be even clearer, say 110%, I would add that there must be some absolutely excellent PAs out there, just like there must be some absolutely rank GPs – so that, in an ‘Is this a PE?’ diagnosis-off, there will be the odd occasion where the PA gets the PE, while the GP gets the GMC.
But. And it’s a ‘but’ visible from space. Sooner or later, something like this was bound to happen. Put non-doctors – whether PAs, advanced nurse practitioners (ANPs), first contact pharmacists or extended role tea ladies – at front of house, then, at some point, they will be working beyond their skill/knowledge set and/or without adequate supervision, and disaster will ensue. For the simple reason that it’s not easy spotting the needle of catastrophe in the haystack of dross but, all things considered, actual GPs are the best at doing this.
Just like they’re also good at the diametric opposite: tolerating uncertainty. Again, this is something noctors are less comfy with, resulting in over-investigation and over-referral – less headline grabby than missing a life-threatening problem, but in the great scheme of things, arguably the greater issue.
Add to this the lack of clarity – whether by accident or design – over whether the patient is actually seeing a ‘proper’ doctor or not, and you have the toxic mix of an inflated level of trust from the patient and a deflated level of clinical acumen from the ‘physician’.
Which doesn’t mean, of course, that PAs and the like don’t have a role – though such was the shock in this particular case that the practice seems to have disassociated itself from physician associates entirely. But it does mean that tragedies will happen, more often than they would if general practice was fronted by GPs. That 10 years of training is there for a reason.
And, to be 120% clear on this, the responsibility here lies squarely with the Government. General practice has been boxed into a corner where health policy has, on the one hand, dismally failed to address the GP workforce issue, and on the other, virtually mandated the use of quasi doctors, and with that you get quasi medicine.
I’d tell my MP face to face, but I assume I’d just get to see the politician associate.
Dr Copperfield is a GP in Essex. Read more of his blogs here