Be wary of the 'Physician Associate', the dilutees of the medical profession.

 

It's already difficult to get to see a GP as an NHS patient. The problem seems to stem from when the government imposed lockdown restrictions because of COVID in March 2020. Many GP practices stopped having walk-in surgeries and became reluctant to see patients face-to-face. They said this was to prevent the spread of the COVID virus. They introduced a system of triage and even when lockdown restrictions were relaxed or ended, many didn't reinstate the walk-in surgery.

At the time, you could see a dentist, optician, or a hospital doctor, but the GPs, were still reluctant to see patients face-to-face and that continues to this day. Many GP practices will now offer you a telephone or a Skype consultation with a GP, or an appointment with a physiotherapist, nursing practitioner, physician associate, or a nurse. What you get offered by the practice, is very much determined by what the practice receptionist writes down when they speak to you on the telephone, if you can make contact with them.  Although they're not medically qualified, they've become the gatekeepers to what medical treatment you might be offered or what services.

Those doctors who work in general practice complain about a lack of GPs, but the medical profession has a vested interest in limiting the number of qualified doctors, in order to maintain their bargaining power and status. Nevertheless, the doctors' union the British Medical Association (BMA), accuses the government of presiding over the 'managed decline' of the NHS, and there's certainly a lot of truth in this.

The Tory government of Rishi Sunak, are planning to introduce an army of de-skilled dilutee's into general medical practice and into NHS hospital A&E departments. Known as "physician associates", they spend less time in medical training than a GP - two years rather than six years for a qualified doctor - and are paid less money. They plan to have 10,000 on the payroll by 2036/37.

Some people, like the family of Emily Chesterton, have expressed concern about the use of less medically qualified people to treat and diagnose patients. Emily, an actress, from Salford, died last October from a blood clot on the lung at the age of 30. A physician associate at the Vale Practice surgery in north London, diagnosed her as suffering from 'anxiety'. This had fatal consequences for the actress who later suffered a cardiac arrest on the way to the hospital.  Emily thought she'd been seen by a GP. Her symptoms included calf pain and shortness of breath, which could have indicated a pulmonary embolism. The physician associate who she'd seen twice, prescribed anti-anxiety pills. The coroner ruled that if Emily had been properly diagnosed with a lung clot and sent to A&E, this would probably have saved her life.

What the Sunak government are proposing to do in de-skilling medicine, resembles what the French did in 1803, when they introduced the post of 'Officier de Sante' (health officer). The health officer spent just three years in medical training compared with six years for a physician. Yet, they were limited in their scope of practice to general medicine, prescribing medications, and minor surgical procedures. They were often deployed to work in medically underserved areas. The post was abolished in 1892.

One of the most famous health officer's in French literature, is the fictional character of Charles Bovary, who appears in Gustave Flaubert's novel 'Madame Bovary'. The husband of Emma Bovary', he's the local 'Officier de Sante'. He becomes convinced that he can cure the village stable boy's club foot with a simple tendon cutting operation. This he believes will enhance his medical status and that of the village. The boy, Hippolyte, nearly dies when his leg becomes infected with gangrene. Bovary has to summon a qualified consultant from another town, who has to amputate the stable boy's leg. The consultant, Monsieur Canivet, a real MD from Nuefchatel, tells Bovary that only a bloody fool would think that anyone could cure a club foot by cutting the patients Achilles tendon. He says people like Bovary ruin the reputation of doctors everywhere with their ridiculous procedures. I wonder what Flaubert would have made of the physician associate? Caveat emptor!