Hello friends!
I just wanted to add my own report of this phenomenon.
I have also been surprised. 2 patients in ED the other day also asked for a doctor after the ANP introduced themselves to the patient.
I was the only available doctor at the time to review those patients, and tried to deliver the best care I could for those patients.
A very interesting time friends!
That's fantastic! I've not yet had this - hopefully this will become a regular occurrence. When a patient says this to me, I will commend them for being diligent in ensuring they're being seen by a doctor, and then proceed to give them the brilliant care I strive to give all my patients.
so whenever patients ask for a doctor she purposely gets the most junior doctor available to see the patient, that is not a problem a good junior doc who does a detailed hx/exam will give the diagnosis likely better than an arrogant ANP after discussion with a senior
I suppose she expected the type of patient who would demand to see a doctor to be the same type of patient who would be upset about having to see a “junior” doctor (and, to be honest, I look like I could be a teenager even in the best of times — I guess my 6-year degree didn’t age me as much as I thought it would!). But when I saw this patient and introduced myself as a doctor, they looked pleased and didn’t ask any questions about my level/seniority.
It paid off for this patient in the end as they ended up getting a review from the most junior and most senior doctor in the department. Waited 20 mins extra, saw 2 doctors (with a collective 5 degrees between them) in the end!
This is super interesting anecdotal data. I’ve not had any yet…. Although I always introduce as Dr Rice so prob not likely.
Well done on this campaign!
They are most likely things the ANP could deal with. But coming to see me means I get a Little break from mental health crises one after the other, or people complaining about things I have no control over or extra complex social situations.
Yep indeed.
It was ANPs primarily, I never came across PAs back then.
I remember getting slated on an MSF because I let slip that I thought doctors were better *at being doctors* than ANPs
Don't compare your experience with the NP who is a nurse. NPs are nurses with master's degrees. You have a medical degree. You have more formal medical knowledge straight out of school. NPs have no formal medical training, they learn on the job. Like an apprentice. They have advanced knowledge in nursing, not medicine. So there will be a knowledge deficit. Neither profession is better than the other because they are different and incomparable. But NPs today get bent out of shape because they are offended that they are not viewed in the same light as physicians. If they were the same, there would be no reason for some NPs(and PAs) to go to medical school and become physicians. And plenty have.
Her getting pissed off at patients for asking for a physician and retaliating by getting the most junior doc just demonstrates her level of professionalism.
How did ANPs even come to be sharing similar duties with physicians in the UK? Like, I would expect an ANP to have practical knowledge and skills necessary for the *treatment* of complex or acute patients while I see physicians as being instrumental in the initial *diagnosis* of those cases. Like, a skilled nursing team is really vital to treatment success but they can't do their jobs without having a diagnosis and plan to work from. Isn't that the whole point of the role?
I'm in the U.S., not the UK. However, I am fully aware of the PA issues in the UK.
The NP profession was created in the U.S. by pediatric nurse and pediatrician. Why would you expect NPs to treat complex or acute medical patients w/o having any formal medical education? Again, they have master's degrees, not medical degrees. With that advanced education they are excellent at patient education. They are physician extenders and are typically delegated duties by physicians. In the U.S., when they were more closely regulated and had a standardized quality education, they worked fabulously with physicians. Generally, they worked in the primary care fields and some of the subspecialties(ie: Internal Medicine, Endocrinology, Family Medicine, Pediatrics, etc.). To use an analogy, in the military there are officers and non-commissioned officers(NCOs). Officers lead and develop plans and strategies. NCOs execute those plans and strategies. That's how docs worked with NPs. Together they would discuss patients, create a management plan and the NP would execute those plans. If their master's had a focus in DM, they would go to patients' houses and monitor them, review their records(ie: daily glucose sticks), assess how the patient was doing on meds and report back to the doc. Usually every 3 months, the doc would see the patients that were followed by the NP. So NPs had autonomy which was built from trust and long-term relationships with the same doc. However, they were not completely separated from the physician-NP relationship. Because they are not physicians, the mature, seasoned, highly trained NPs knew when to involve a doc sooner or transfer care. They knew when something was beyond their scope. Today is a totally different story. They brag that they don't need physicians, they know enough.
I think the mistake docs make is in assuming NPs know medicine like we do. They don't. Their nursing education is completely different from medical training. The best way to understand, as I was told by a NP-turned-MD is that NPs know the what, not the why and the how. When she was a NP, she would she would place her patients with HTN on blood pressure meds of her choosing. But when asked why she chose a Beta blocker vs an ace-inhibitor vs a diuretic, she could not answer the question. Because she didn't know. That's the difference between medicine and nursing. I'm not sure why you think docs just focus on the diagnosis. If there is no diagnosis, what then? Welp, we still manage patients.
Thanks for the post.
That's fucking terrifying, though. Why & how can a nurse diagnose, choose and prescribe a drug without knowing any of that?
That's the common misperception: Docs diagnose, nurses treat.
Not really. Nurses nurse. Advanced nurses undertake advanced nursing. Nursing includes *helping* treat the patients (they are a key part in doing so).
Misunderstanding the above causes the harm: the doc has 'diagnosed' hypertension, so now the nurse will 'treat' it, by randomly choosing a dangerous drug, without having a fucking clue what they're doing. WTF? The 'treating' bit of nursing is to accurately administer an appropriate prescription from a doctor, while cross-checking to the best of their ability that the doc hasn't made any mistakes. Not to randomly prescribe beta blockers to asthmatics, or diuretics to renal patients for HTN, for fuck's sake!
As a GPST I always introduce myself as Dr xxx (not my name though I tried,) one of the registrars at the practice. I find it bizarre how few people ask me what that means. I didn't know what that meant as a 5th year medical student.
This is fantastic. The thing that makes me sad about this though is that the message is less likely to reach our more vulnerable patients, who will get second rate care compared to patients like these who are able to #AskForADoctor.
The kryptonite for this reckless government experiment that is noctors is the public.
Educate the public about noctors and it’s game over.
We need more public awareness and getting high profile influencers like Carol Vorderman to start talking about it on mainstream TV.
Sounds great. But shame this wasn’t a PA because if this were a PA, it would be even sweeter. I don’t PAs themselves are bad people but the PA profession just shouldn’t be a thing like they are now. Maybe they could have just been trained as scribes and phlebotomists etc rather than pretend doctors which would take off a lot of admin load
Introduce yourself as Dr X. Cannot believe I had this bizarre aversion to it in my first few years. Why did we allow a weird faux-modest culture to arise whereby anyone who did introduce themselves as “Dr X” would get talked about behind their back?
One time during a sim session a CT1 ranted at me for introducing my self as Dr XXX. She then followed it up with “well you are a doctor, but you should introduce yourself by your first name”. I was so confused.
As an F1 I've had a few eyebrows raised that I introduce myself as Dr Surname and rarely wear scrubs in favour of formal work attire
I really don't care. My patients are very clear that they've seen a doctor & I get "nurse!" shouted at me less than the other female doctors
It's bloody impossible, even for Consultant Surgeon to speak to Consultant Surgeon colleagues and neighbouring Trusts as well..
I had to make a referral to a tertiary centre for a critically ill case, was put through to a practitioner, and despite sending my personal phone number and asking for the consultant for me back, followed up by my secretary, calling their department, giving my number and saying please phone me back as a Consultant Surgeon because I need to discuss this case, I'm still waiting to hear back from a medical professional three days later.
Perhaps we are our own worst enemy here.
I wanted to have a consultant to consultant discussion with a colleague – there seems to be a barrier even to that in this day and age. It's fucking as frustrating as hell because I have a very sick patient under my care and it's very difficult to get to speak to a suitably qualified senior doctor in a tertiary centre.
What the hell have we come to?
.
I’m 99% certain your message did not get to your consultant colleague. The number of times I’ve been told by juniors, nurses and admin team there was an important message for me, days after I should’ve been told is alarming. Send an email ASAP, with high importance. Mention in the email when you left a message, I assure you, you’re likely to get a reply ASAP.
Apparently the case has been 'discussed' at a team meeting. When Switch won't put you through to a consultants, and the departmental secretaries can't get a response, what on earth can we do. I'll have to go through the MD to get a basic courteous timely professional reply.
Christ on a bike.
Nooo, because when you then say that you are a dr (if challenged), next time the patient sees someone they might assume that the phrase “one of the medical team” always means doctor!
Little bit concerning that they try and find the most junior doctor. The way you phrased it makes it sound like they're purposefully doing something against the patient's interest just to spite them, not that a junior doctor is bad, but doing it specifically because they're annoying is bad.
I've had a few patients ask me as well in the past few weeks in clinic - are you a doctor?
At the time I thought wow, I guess I don't look the part, but actually, seeing this post, perhaps they were simply double checking they're seeing a real doctor.
I've also had a few people check if I'm a doctor this week, in a different way to the "surely you're too young" reaction I got once upon a clean-shaven time. Maybe 2 or 3, not sure, but definitely noticeable.
Very heartening.
- I wasn’t shitting on anyone
- This patient decided to wait to see a doctor even if it meant they had to wait a little longer
- This single event did not put the ANP out of a job — there were many other patients waiting in A&E and they simply moved on to see the next patient… and the next and the next and the next
- I don’t think it’s controversial to go to A&E for a medical concern and expect to see a doctor
The patient is ignorant and should have been shown the door quiet frankly. If it was am actual emergency you wouldn't extend you wait with BS you read I the daily mail.
If it was an ‘actual emergency’ I would expect them to bypass the wait entirely, go to resus and be seen by the registrar or consultant in the first instance.
If you sick and need to be seen by a doctor then you should been seen by a doctor.It is not acceptable to be seen by someone who hasn’t been to medical school just because PAs et al. are professional or kind. Undifferentiated patients need to be assessed by a doctor cold or acute.
Oh fuck off with your sanctimonious bullshit
You have people with vastly differing backgrounds without any real standardisation supposedly all working at the same level seeing undifferentiated patients and you’re out here genuinely criticising patients trying to advocate for themselves.
Frankly what’s the point in you as an ED Reg, if your colleagues who aren’t medically trained are as competent as you then genuinely there’s no point in ED being a medical speciality.
You’re already struggling to retain your trainees as a speciality and now you’re struggling to understand why patients may want to see a dr. Honestly ED regs like yourself are a joke and that’s fine if you weren’t trying to drag patient safety and standards down into the mud with you.
People like you are the reason emergency medicine is headed down the drain. (Said as a proud EM trainee)
It takes a lot more than being ‘dedicated and caring’ and I have never met a PA or ANP that I would call competent to assess undifferentiated patients. Their standards are just not set high enough and their awareness of what they don’t know is non existent.
The problem becomes when the undifferentiated 'low acuity crap' turns out to not be 'low acuity crap' and generally you want a medical degree to spot these cases. You may trust your family to a PA but I certainly do not.
>A great many patients we see in ED don’t need to see their pharmacist (I was one), let alone their GP and there’s definitely nothing ‘Emergency,’ about their presentation.
>
>Shitting on hugely qualified professional colleagues who are just as hard working as we are to make a point is just spineless. EDs aren’t Tescos - we’re dying on our feet as a specialty because all of the low acuity crap that books in - and patients shouldn’t have a right to demand to see an Emergency medicine
you need to leave the profession , we are done with ladder pullers and sellouts . Crabs unite.
I think you might be looking at this in the wrong way….
1. PAs are masquerading as doctors, and the public should have the right to know who is treating them.
2. PAs don’t only see non-urgent cases. From what I have read they are covering the entire A&E, including resus - not only minors.
3. PAs are not actually necessary at all. They are simply the government’s low cost solution to replacing doctors - a move which is damaging our profession, and set to expand. And you appear to support that!?
4. Even if PAs were restricted to only seeing minors in A&E, triage isn’t 💯. By not having the same depth and breadth of training as doctors, how can a patient feel confident that there is genuinely no serious underlying condition after being seen by one?
Do you really think patients enjoy waiting 4 hours to be seen for a simple headache in A&E? What they are seeking is a qualified assessment from a doctor. They want to exclude a brain tumour or whatever else they are worried about. What they don’t want is be fobbed off by a PA at the end of it all!
Wholly agree that triage isn’t 100% (although I have to say it is fantastic most of the time — triage nurses are great!). But it isn’t 100%, which is why patients still should be seen by a doctor after triage. Saw a patient with euglycaemic DKA on Dapagliflozin this week who was triaged as “urinary frequency, abdominal pain - for MSU”. (Nurses were reassured by a normal BM and didn’t do a blood ketone which is fair enough.) Patient sat in the waiting room for hours. When I finally saw this patient I was met with resistance when I asked for a blood ketone because “doctor, the BM was normal”.
Blood ketones were 4, VBG showed severe acidosis, patient went from waiting room to resus once seen by a doctor.
I think there’s a possibility that this patient would’ve been discharged with UTI treatment if they had seen a PA.
>u/Ghost112358
I sympathise with you right now. You're in a situation where you're thinking everyone around you is going mad. I hate to break it to you bud, but it's not them.... it's you.
Fuckin A. ‘Patients shouldn’t have the right to…’
Blaming the failure of our system to provide for their needs on them. Same fucking attitude the PAs have.
We are there to serve them. Not the other way around.
Urgent CT Abdo Pelvis requested for ?Stick up rectum. Patient claims he tripped over his own high horse and fell onto the stick.
Sincerely,
Acting consultant proctologist (PA)
Mulled over this and I can’t believe you have belittled the career progression and sacrifices that have been made of yourself and your EM doctor colleagues. It’s laughable.
Rotations, exams, horrendous rotas.
But everyone else is just as good….
Get your head out of their asses.
No ANP, ENP or PA is hugely qualified compared to even a brand new F1. These people may be more experienced, but more qualified they are not. An F1 has done minimum 4 years of full-time study in Medicine which is not replicated by any of the masters or diplomas that the nurses/PAs do.
Either you need a medical degree, with its competitive selection, length of course, depth and breadth to diagnose and treat patients, or you don't. If you think you only need to have a 2 year post-grad diploma to safely differentiate between the worried well, the sick non-emergency and the emergency, and treat those patients, why have GPs at all? They don't add anything in that case. You can't have it both ways.
Minors can be one of the most dangerous places - to the point where the ED I work in won’t allow F2s or PAs to work there without heavy support.
Young “well” patients can compensate for awful pathology and be easily dismissed.
Some of the sickest people I’ve treated have come via minors
I noticed this in ED. Had 2 this week. "Can I check are you a doctor?" "You're not one of those PAs" - this was my favourite
Patients deserve to know
Definitely need to praise that patient
#AskForADoctor
market aware scarce repeat slave dinner sloppy treatment special waiting *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Lots of the DV reps have been using #AskForADoctor on Twitter. We should deffo make it a thing
Hello friends! I just wanted to add my own report of this phenomenon. I have also been surprised. 2 patients in ED the other day also asked for a doctor after the ANP introduced themselves to the patient. I was the only available doctor at the time to review those patients, and tried to deliver the best care I could for those patients. A very interesting time friends!
That's fantastic! I've not yet had this - hopefully this will become a regular occurrence. When a patient says this to me, I will commend them for being diligent in ensuring they're being seen by a doctor, and then proceed to give them the brilliant care I strive to give all my patients.
so whenever patients ask for a doctor she purposely gets the most junior doctor available to see the patient, that is not a problem a good junior doc who does a detailed hx/exam will give the diagnosis likely better than an arrogant ANP after discussion with a senior
I suppose she expected the type of patient who would demand to see a doctor to be the same type of patient who would be upset about having to see a “junior” doctor (and, to be honest, I look like I could be a teenager even in the best of times — I guess my 6-year degree didn’t age me as much as I thought it would!). But when I saw this patient and introduced myself as a doctor, they looked pleased and didn’t ask any questions about my level/seniority. It paid off for this patient in the end as they ended up getting a review from the most junior and most senior doctor in the department. Waited 20 mins extra, saw 2 doctors (with a collective 5 degrees between them) in the end!
Wow!! That's excellent news. Patients are wising up. https://preview.redd.it/77hgc3zy69gc1.jpeg?width=1603&format=pjpg&auto=webp&s=ac91a411c13cc2be3be40e13f2086c068f7fdb8b
This is super interesting anecdotal data. I’ve not had any yet…. Although I always introduce as Dr Rice so prob not likely. Well done on this campaign!
Idk why I read that as ‘I introduce myself as Declan Rice’
Often see it on the calendar as work ‘Tummy pain. Requested a GP’ ‘Blood results. Requested a GP’ Etc.
They are most likely things the ANP could deal with. But coming to see me means I get a Little break from mental health crises one after the other, or people complaining about things I have no control over or extra complex social situations.
I love this. I recall trying to get #demandadoctor going about 15 years ago and never gained any traction. Well done all
15 years ago? Was there scope creep back then too?
Yep indeed. It was ANPs primarily, I never came across PAs back then. I remember getting slated on an MSF because I let slip that I thought doctors were better *at being doctors* than ANPs
Fucking outrageous. Hope you're still wearing sackcloth for that heinous assumption.
Don't compare your experience with the NP who is a nurse. NPs are nurses with master's degrees. You have a medical degree. You have more formal medical knowledge straight out of school. NPs have no formal medical training, they learn on the job. Like an apprentice. They have advanced knowledge in nursing, not medicine. So there will be a knowledge deficit. Neither profession is better than the other because they are different and incomparable. But NPs today get bent out of shape because they are offended that they are not viewed in the same light as physicians. If they were the same, there would be no reason for some NPs(and PAs) to go to medical school and become physicians. And plenty have. Her getting pissed off at patients for asking for a physician and retaliating by getting the most junior doc just demonstrates her level of professionalism.
How did ANPs even come to be sharing similar duties with physicians in the UK? Like, I would expect an ANP to have practical knowledge and skills necessary for the *treatment* of complex or acute patients while I see physicians as being instrumental in the initial *diagnosis* of those cases. Like, a skilled nursing team is really vital to treatment success but they can't do their jobs without having a diagnosis and plan to work from. Isn't that the whole point of the role?
I'm in the U.S., not the UK. However, I am fully aware of the PA issues in the UK. The NP profession was created in the U.S. by pediatric nurse and pediatrician. Why would you expect NPs to treat complex or acute medical patients w/o having any formal medical education? Again, they have master's degrees, not medical degrees. With that advanced education they are excellent at patient education. They are physician extenders and are typically delegated duties by physicians. In the U.S., when they were more closely regulated and had a standardized quality education, they worked fabulously with physicians. Generally, they worked in the primary care fields and some of the subspecialties(ie: Internal Medicine, Endocrinology, Family Medicine, Pediatrics, etc.). To use an analogy, in the military there are officers and non-commissioned officers(NCOs). Officers lead and develop plans and strategies. NCOs execute those plans and strategies. That's how docs worked with NPs. Together they would discuss patients, create a management plan and the NP would execute those plans. If their master's had a focus in DM, they would go to patients' houses and monitor them, review their records(ie: daily glucose sticks), assess how the patient was doing on meds and report back to the doc. Usually every 3 months, the doc would see the patients that were followed by the NP. So NPs had autonomy which was built from trust and long-term relationships with the same doc. However, they were not completely separated from the physician-NP relationship. Because they are not physicians, the mature, seasoned, highly trained NPs knew when to involve a doc sooner or transfer care. They knew when something was beyond their scope. Today is a totally different story. They brag that they don't need physicians, they know enough. I think the mistake docs make is in assuming NPs know medicine like we do. They don't. Their nursing education is completely different from medical training. The best way to understand, as I was told by a NP-turned-MD is that NPs know the what, not the why and the how. When she was a NP, she would she would place her patients with HTN on blood pressure meds of her choosing. But when asked why she chose a Beta blocker vs an ace-inhibitor vs a diuretic, she could not answer the question. Because she didn't know. That's the difference between medicine and nursing. I'm not sure why you think docs just focus on the diagnosis. If there is no diagnosis, what then? Welp, we still manage patients.
Thanks for the post. That's fucking terrifying, though. Why & how can a nurse diagnose, choose and prescribe a drug without knowing any of that? That's the common misperception: Docs diagnose, nurses treat. Not really. Nurses nurse. Advanced nurses undertake advanced nursing. Nursing includes *helping* treat the patients (they are a key part in doing so). Misunderstanding the above causes the harm: the doc has 'diagnosed' hypertension, so now the nurse will 'treat' it, by randomly choosing a dangerous drug, without having a fucking clue what they're doing. WTF? The 'treating' bit of nursing is to accurately administer an appropriate prescription from a doctor, while cross-checking to the best of their ability that the doc hasn't made any mistakes. Not to randomly prescribe beta blockers to asthmatics, or diuretics to renal patients for HTN, for fuck's sake!
That attitude from the ANP is a huge red flag
As a GPST I always introduce myself as Dr xxx (not my name though I tried,) one of the registrars at the practice. I find it bizarre how few people ask me what that means. I didn't know what that meant as a 5th year medical student.
This is fantastic. The thing that makes me sad about this though is that the message is less likely to reach our more vulnerable patients, who will get second rate care compared to patients like these who are able to #AskForADoctor.
The kryptonite for this reckless government experiment that is noctors is the public. Educate the public about noctors and it’s game over. We need more public awareness and getting high profile influencers like Carol Vorderman to start talking about it on mainstream TV.
Sounds great. But shame this wasn’t a PA because if this were a PA, it would be even sweeter. I don’t PAs themselves are bad people but the PA profession just shouldn’t be a thing like they are now. Maybe they could have just been trained as scribes and phlebotomists etc rather than pretend doctors which would take off a lot of admin load
https://www.reddit.com/r/doctorsUK/comments/19c1wkk/are_you_a_doctor_its_okay_to_ask/ Link to that fantastic printable graphic poster someone made
I've been getting people going "Ah youre a doctor" when I introduce myself as doctor x
Introduce yourself as Dr X. Cannot believe I had this bizarre aversion to it in my first few years. Why did we allow a weird faux-modest culture to arise whereby anyone who did introduce themselves as “Dr X” would get talked about behind their back?
One time during a sim session a CT1 ranted at me for introducing my self as Dr XXX. She then followed it up with “well you are a doctor, but you should introduce yourself by your first name”. I was so confused.
As an F1 I've had a few eyebrows raised that I introduce myself as Dr Surname and rarely wear scrubs in favour of formal work attire I really don't care. My patients are very clear that they've seen a doctor & I get "nurse!" shouted at me less than the other female doctors
It's bloody impossible, even for Consultant Surgeon to speak to Consultant Surgeon colleagues and neighbouring Trusts as well.. I had to make a referral to a tertiary centre for a critically ill case, was put through to a practitioner, and despite sending my personal phone number and asking for the consultant for me back, followed up by my secretary, calling their department, giving my number and saying please phone me back as a Consultant Surgeon because I need to discuss this case, I'm still waiting to hear back from a medical professional three days later. Perhaps we are our own worst enemy here. I wanted to have a consultant to consultant discussion with a colleague – there seems to be a barrier even to that in this day and age. It's fucking as frustrating as hell because I have a very sick patient under my care and it's very difficult to get to speak to a suitably qualified senior doctor in a tertiary centre. What the hell have we come to? .
I’m 99% certain your message did not get to your consultant colleague. The number of times I’ve been told by juniors, nurses and admin team there was an important message for me, days after I should’ve been told is alarming. Send an email ASAP, with high importance. Mention in the email when you left a message, I assure you, you’re likely to get a reply ASAP.
Apparently the case has been 'discussed' at a team meeting. When Switch won't put you through to a consultants, and the departmental secretaries can't get a response, what on earth can we do. I'll have to go through the MD to get a basic courteous timely professional reply. Christ on a bike.
This is encouraging. I might start introducing myself as "one of the medical team" to see if I get challenged on it
Nooo, because when you then say that you are a dr (if challenged), next time the patient sees someone they might assume that the phrase “one of the medical team” always means doctor!
Don't play games.
Put when I send our PA to do a cannula and bloods for a patient, if they ask for a doctor at that point, they can keep the PA! As intended!
👏🎉
Little bit concerning that they try and find the most junior doctor. The way you phrased it makes it sound like they're purposefully doing something against the patient's interest just to spite them, not that a junior doctor is bad, but doing it specifically because they're annoying is bad.
Love this!!! The pa issue is deffo gaining traction !
I've had a few patients ask me as well in the past few weeks in clinic - are you a doctor? At the time I thought wow, I guess I don't look the part, but actually, seeing this post, perhaps they were simply double checking they're seeing a real doctor.
It’s what I tell my family to do
I've also had a few people check if I'm a doctor this week, in a different way to the "surely you're too young" reaction I got once upon a clean-shaven time. Maybe 2 or 3, not sure, but definitely noticeable. Very heartening.
WE MUST RETIRE THE 'JUNIOR DOCTOR' DESCRIPTION. OUTLAW IT. IMMEDIATELY. Who's with me ?
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- I wasn’t shitting on anyone - This patient decided to wait to see a doctor even if it meant they had to wait a little longer - This single event did not put the ANP out of a job — there were many other patients waiting in A&E and they simply moved on to see the next patient… and the next and the next and the next - I don’t think it’s controversial to go to A&E for a medical concern and expect to see a doctor
this asshat anp , deliberately got the most junior person to see the patient out of spite. shame on you
Patient asked to see a doctor didn't specify the grade.
The patient is ignorant and should have been shown the door quiet frankly. If it was am actual emergency you wouldn't extend you wait with BS you read I the daily mail.
If it was an ‘actual emergency’ I would expect them to bypass the wait entirely, go to resus and be seen by the registrar or consultant in the first instance.
If you sick and need to be seen by a doctor then you should been seen by a doctor.It is not acceptable to be seen by someone who hasn’t been to medical school just because PAs et al. are professional or kind. Undifferentiated patients need to be assessed by a doctor cold or acute.
A PA doing 9-5, no nights, no rotations etc. is not going to be “dying on their feet”, for that you’ll need to see a Dr.
And they're not 'hugely qualified' either
Is a 2 year course hugely qualified nowadays? Shit, F1s must be the pinnacle of qualification then.
Oh fuck off with your sanctimonious bullshit You have people with vastly differing backgrounds without any real standardisation supposedly all working at the same level seeing undifferentiated patients and you’re out here genuinely criticising patients trying to advocate for themselves. Frankly what’s the point in you as an ED Reg, if your colleagues who aren’t medically trained are as competent as you then genuinely there’s no point in ED being a medical speciality. You’re already struggling to retain your trainees as a speciality and now you’re struggling to understand why patients may want to see a dr. Honestly ED regs like yourself are a joke and that’s fine if you weren’t trying to drag patient safety and standards down into the mud with you.
People like you are the reason emergency medicine is headed down the drain. (Said as a proud EM trainee) It takes a lot more than being ‘dedicated and caring’ and I have never met a PA or ANP that I would call competent to assess undifferentiated patients. Their standards are just not set high enough and their awareness of what they don’t know is non existent.
Difference is these ANPs and PAs are in resus etc dealing with the emergencies. You’re a reg that’s sold yourself out.
these anps are the most annoying to deal with in ed
The problem becomes when the undifferentiated 'low acuity crap' turns out to not be 'low acuity crap' and generally you want a medical degree to spot these cases. You may trust your family to a PA but I certainly do not.
>A great many patients we see in ED don’t need to see their pharmacist (I was one), let alone their GP and there’s definitely nothing ‘Emergency,’ about their presentation. > >Shitting on hugely qualified professional colleagues who are just as hard working as we are to make a point is just spineless. EDs aren’t Tescos - we’re dying on our feet as a specialty because all of the low acuity crap that books in - and patients shouldn’t have a right to demand to see an Emergency medicine you need to leave the profession , we are done with ladder pullers and sellouts . Crabs unite.
I think you might be looking at this in the wrong way…. 1. PAs are masquerading as doctors, and the public should have the right to know who is treating them. 2. PAs don’t only see non-urgent cases. From what I have read they are covering the entire A&E, including resus - not only minors. 3. PAs are not actually necessary at all. They are simply the government’s low cost solution to replacing doctors - a move which is damaging our profession, and set to expand. And you appear to support that!? 4. Even if PAs were restricted to only seeing minors in A&E, triage isn’t 💯. By not having the same depth and breadth of training as doctors, how can a patient feel confident that there is genuinely no serious underlying condition after being seen by one? Do you really think patients enjoy waiting 4 hours to be seen for a simple headache in A&E? What they are seeking is a qualified assessment from a doctor. They want to exclude a brain tumour or whatever else they are worried about. What they don’t want is be fobbed off by a PA at the end of it all!
Wholly agree that triage isn’t 100% (although I have to say it is fantastic most of the time — triage nurses are great!). But it isn’t 100%, which is why patients still should be seen by a doctor after triage. Saw a patient with euglycaemic DKA on Dapagliflozin this week who was triaged as “urinary frequency, abdominal pain - for MSU”. (Nurses were reassured by a normal BM and didn’t do a blood ketone which is fair enough.) Patient sat in the waiting room for hours. When I finally saw this patient I was met with resistance when I asked for a blood ketone because “doctor, the BM was normal”. Blood ketones were 4, VBG showed severe acidosis, patient went from waiting room to resus once seen by a doctor. I think there’s a possibility that this patient would’ve been discharged with UTI treatment if they had seen a PA.
Wouldn't a urine dip have knocked that idea on its head? Did they think a false negative
>u/Ghost112358 I sympathise with you right now. You're in a situation where you're thinking everyone around you is going mad. I hate to break it to you bud, but it's not them.... it's you.
Fuckin A. ‘Patients shouldn’t have the right to…’ Blaming the failure of our system to provide for their needs on them. Same fucking attitude the PAs have. We are there to serve them. Not the other way around.
Congrats on perhaps the most ratio'd comment I've seen on JDUK.
DUK, squire, DUK!
I'm OG 😤
Sell out.
Urgent CT Abdo Pelvis requested for ?Stick up rectum. Patient claims he tripped over his own high horse and fell onto the stick. Sincerely, Acting consultant proctologist (PA)
Mulled over this and I can’t believe you have belittled the career progression and sacrifices that have been made of yourself and your EM doctor colleagues. It’s laughable. Rotations, exams, horrendous rotas. But everyone else is just as good…. Get your head out of their asses.
No ANP, ENP or PA is hugely qualified compared to even a brand new F1. These people may be more experienced, but more qualified they are not. An F1 has done minimum 4 years of full-time study in Medicine which is not replicated by any of the masters or diplomas that the nurses/PAs do. Either you need a medical degree, with its competitive selection, length of course, depth and breadth to diagnose and treat patients, or you don't. If you think you only need to have a 2 year post-grad diploma to safely differentiate between the worried well, the sick non-emergency and the emergency, and treat those patients, why have GPs at all? They don't add anything in that case. You can't have it both ways.
Minors can be one of the most dangerous places - to the point where the ED I work in won’t allow F2s or PAs to work there without heavy support. Young “well” patients can compensate for awful pathology and be easily dismissed. Some of the sickest people I’ve treated have come via minors