Kindness is a virtue…but not the only one

Editor Jaimie Kaffash argues that Lord Bethell’s focus on the ‘bullying’ of physician associates only is a distraction from his government’s role in worsening NHS case

You’ve probably seen Lord Bethell’s piece on our site. If ever the sentence ‘this does not necessarily reflect the views of Pulse’ applies, it is here. I’ve had a few people ask why Pulse published this, and it is a valid question. My answer is that what he is saying is in the public interest for our audience – he is a high-profile figure who is attacking the profession, and it is useful for our readers to know the line of attack. If you don’t agree with this logic, I completely get that.

But it does give us the opportunity to scrutinise some of the arguments around the physician associate debate – and to me, they are a window into what is a quite sinister tactic being employed regularly by his government.

The peer claims that PAs were being ‘ritually humiliated’, facing ‘bullying and intimidation… on a routine basis at work and on social media’, with ‘rotas and private personal details’ being leaked, individuals being ‘victimised, and defamed on social media for being a medical associate’. He added that there were ‘implausible claims’ about patient safety, with some PAs ‘receiving death threats’.

It goes without saying that – if true – this is all appalling. But we have laws (both criminal and civil) to deal with this type of thing. If true, anyone indulging in this kind of behaviour should be dealt with appropriately.

But what he is really doing by focusing on doctors’ behaviour on Twitter (I can’t bring myself to call it ‘X’) is creating a diversion tactic to keep us away from the real issues.

Discussions around the tone of the message is a way to prevent us from considering scandal, and it is something that governments love. And right now, it is becoming as sinister as ever – being used to crack down on protests.  

In the case of PAs, this is not some minor little spat on social media. PAs being used to take on doctors’ jobs is result of the decade’s long lowering of standards in the NHS and indeed all public services. This is the crux of the issue.

The vast majority of criticisms are valid, and based on patient safety concerns. As I have argued previously, I don’t feel like focusing on the most egregious examples is helpful. Doctors also make mistakes, as does everyone, and one individual’s mistake isn’t an indictment of the whole profession (GPs know this more than most).

This is a systemic issue. Individual mistakes will happen, and some will be a direct result of lesser trained health care staff taking on tasks they don’t have the competence for. But far more likely is a reversion to ultra-cautious medicine, where more patients are medicalised, and more unnecessary referrals and investigations take place leading to a greater strain on the system and avoidable patient anxiety.

Of course individual PAs shouldn’t face abuse. And these professionals are among the most educated people in the country. But the point is they are not doctors, and they don’t have the (minimum) ten years of education and training that doctors undertake. This is the message that Lord Bethell is diverting discussion away from.

So before I finish, I will directly address Lord Bethell’s points. First, he asks, ‘how will our doctors react when artificial intelligence shakes up the healthcare system, as in every other walk of life?’ I would guess they will react badly. They will protest, they will shout and shriek, some may throw their proverbial toys out of the pram. And they will be 100% right in doing so, as any attempts to cut corners through AI will unquestionably cause patient harm.

Then he asks ‘where was the voice of the large majority of perfectly reasonable doctors?’ They were warning about the dangers of using a cheaper, less skilled workforce to do a doctor’s job.

And finally – and fairly insultingly – he cites Pastor Martin Niemöller. It is a grubby game, but if he wants to go there, I say to him this (abridged): ‘First, your government came for social care…then, they came for housing…and now they are coming for health, and we are fuming about it.’

Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk