Why can’t the medicine areas be more broken down?

It might seem dumb to ask but I was really wondering why can’t medicine be more broken down to increase medical doctors and shorten their time studying? Like we need someone to take blood so we can train people to be phlebotomists to take blood. Or if a small part of a patients body needs stitches then a Suturing job can be specifically made where patients with minor injuries can be sutured up. Things that don’t require much knowledge but Needs a while to learn and be professional. Or maybe I’m just not looking at it the right way?

Reply 1

Desideri

17

People already exist to just do those jobs, they’re just not doctors. Health care assistants can take blood, for example, and they don’t need to have gone to uni. Some nurses do minor injuries.

Reply 2

username4347578

OP

20

I know it’s just that I think that it can be broken up just a bit more to carry off the workload that doctors carry

Reply 3

Democracy

20

Original post by ArtmisKco

It might seem dumb to ask but I was really wondering why can’t medicine be more broken down to increase medical doctors and shorten their time studying? Like we need someone to take blood so we can train people to be phlebotomists to take blood. Or if a small part of a patients body needs stitches then a Suturing job can be specifically made where patients with minor injuries can be sutured up. Things that don’t require much knowledge but Needs a while to learn and be professional. Or maybe I’m just not looking at it the right way?

Attempts to "break down" medicine exist in various guises across the world and have done for decades. It's not something new but it has gained traction with many politicians and managers.

Real life medicine is not like assembling flat pack furniture - it's actually very complex and the increasingly algorithmic and reductionist approach to patients is, I think, a bad thing. The point of being a doctor is to think outside the box by having a wide breadth of experience based on sufficient scientific and clinical knowledge. Trying to rush this process and seeing medical training as being about ticking modular boxes results in a Dunning-Kruger version of medicine imho.

The things I always ask myself are: "if the son/daughter/husband/wife of this keen politician or manager were desperately ill, who would they want to treat their loved one, what sort of experience and training would they expect them to have, and why aren't they advocating the same for me?". I think considering the answers to these questions can help clarify matters nicely.

Or thinking about it another way, since we're forever being asked to compare ourselves to the aviation industry, how would the public feel about pilots having their training "broken down" for reasons of quantity and economy? Flying a plane seems much more operational and procedure based than being a doctor, so yeah, why not?

Reply 4

Spencer Wells

12

And it's not just the mechanics of it - yes anyone can be taught how to suture, but knowing when and when not to do it is arguably more important, and requires much more training, experience, and understanding of anatomy and pathophysiology than you'd get from training a technician.

Reply 5

InArduisFouette

21

Original post by Spencer Wells

And it's not just the mechanics of it - yes anyone can be taught how to suture, but knowing when and when not to do it is arguably more important, and requires much more training, experience, and understanding of anatomy and pathophysiology than you'd get from training a technician.

exactly

which is why where you have'technicians' suturing ( i know of a few EDs where band 3 HCAs suture , the Junior Doctor has to perform all the neurovascualr examinationand prescribe exact methods on closure, plus the patient needs to be reviewed by a a suitable professional after the wound is closed ... where in other EDs where none practitioner RNs suture , with 'practitioner level' training to close wounds the Dr literally just rules out major underlying issues writes up 'clean and close' and the Nurse does a full job of assessing the wound and closing it appropriately

also it still surprises me that people are shocked that Nurses ( both none ENP and ENP ) can close in layers or do faces / lips

Reply 6

nexttime

22

Original post by ArtmisKco

It might seem dumb to ask but I was really wondering why can’t medicine be more broken down to increase medical doctors and shorten their time studying? Like we need someone to take blood so we can train people to be phlebotomists to take blood. Or if a small part of a patients body needs stitches then a Suturing job can be specifically made where patients with minor injuries can be sutured up. Things that don’t require much knowledge but Needs a while to learn and be professional. Or maybe I’m just not looking at it the right way?

I think you're right tbh. Yeah many roles are being broken down, but many aren't too.

To use your example, any time you've got doctors doing non-ultrasound guided bloods is a plain waste. I think the number of other roles taking blood has risen sharply in the last 5-10 years, but I guarantee you'll still find doctors with 6 years very expensive training and years of additional experience being asked to do a bloods round every weekend. Guarantee it.

So tbh you're probably more insightful than about 50% of managers out there. Low bar, but congrats anyway.

Reply 7

No_fixed_abode

10

That is a shame. I had thought one of the benefits of having physician associates etc. was so that junior docs would have fewer bloods/TTOs etc in order that they could do things like chest drains and get some training.

Reply 8

Democracy

20

Original post by No_fixed_abode

That is a shame. I had thought one of the benefits of having physician associates etc. was so that junior docs would have fewer bloods/TTOs etc in order that they could do things like chest drains and get some training.

This is what's known in management circles as "schmuck bait". A lot of doctors hgh up in medical education and leadership are Grade A schmucks. Managers are wise to this and use it to their advantage.

Reply 9

Mesopotamian…

21

Well I can think of one major breakdown - dentistry (and that still takes a minimum of 5 years) :redface:

Reply 10

Democracy

20

Original post by Mesopotamian.

Well I can think of one major breakdown - dentistry (and that still takes a minimum of 5 years) :redface:

Really more of a breakdown of barber-surgery than medicine :biggrin:

Reply 11

Mesopotamian…

21

Original post by Democracy

Really more of a breakdown of barber-surgery than medicine :biggrin:

Where's that grim reaper TSR emoji when you need it :mad2:

On a side note, isn't that more applicable to medical surgeons :hmmm:

Reply 12

nexttime

22

Original post by No_fixed_abode

That is a shame. I had thought one of the benefits of having physician associates etc. was so that junior docs would have fewer bloods/TTOs etc in order that they could do things like chest drains and get some training.

Doesn't seem to be how it ends up on the ground. I can think of three reasons:

1) There is a lot of paperwork that needs some high up bureaucrat to say its ok for non-doctors to do it. And we all know how long it takes for high up bureaucrats to get anything actually done. So for example, physician's associate courses advertise themselves as able to make the equivalent of a junior doctor, and they are allowed to assess sick patients do procedures like chest drains etc. But the GMC has to give them permission to be able to prescribe anything (even paracetamol). And they've been discussing whether they can do that for years. No exaggeration. Years.
They also can't request even a simple chest x-ray because it involves radiation. Even though a chest x-ray is about the same radiation as you get from background radiation in a day in some parts of the country anyway.
So what results is the doctor sits and does the prescriptions, writes the discharge paperwork, the physician associate actually sees the patient, does the chest drain etc.

2) A junior doctor is with a department for typically 4 months. A physician associate/nurse practitioner is typically on a permanent contract. When you're a really busy consultant who really needs help with workload, and an opportunity arises to teach someone how to do a chest drain say... who do you pick? The junior doctor who might have no interest in your speciality and might only have a month left... or your PA/NP who chose your speciality, maybe you interviewed and chose to hire, and might be with you for a long time (and might be with you for longer if you throw them bones like this)?

3) Junior doctors have to work where and when they are told - they really have no choice if they want to progress and become a consultant. A PA/NP can quit one job if they don't like it, and work in a different job in the same hospital, or in a neighbouring hospital. This means that the hospital has to make PA/NPs jobs appealing so they are typically given fairly social rotas i.e. 9-5. Whereas junior doctors can be made to do loads of nights and weekends with minimal increase in costs, which of course means they are on the wards less between 9 and 5 than a support role.
And most training opportunities are 9-5.

But not to sound too bitter about it - I've still always managed to get all sign offs I need and the NHS would have collapsed long ago without non-doctor roles stepping up to do what were previously doctor jobs.

Reply 13

Chief Wiggum

20

I don't understand the PA hate from some doctors. Can't complain about being "overworked" and then also complain when help is provided.

Reply 14

No_fixed_abode

10

Original post by Chief Wiggum

I don't understand the PA hate from some doctors. Can't complain about being "overworked" and then also complain when help is provided.

"But not to sound too bitter about it - I've still always managed to get all sign offs I need and the NHS would have collapsed long ago without non-doctor roles stepping up to do what were previously doctor jobs."

Reply 15

Chief Wiggum

20

Original post by No_fixed_abode

"But not to sound too bitter about it - I've still always managed to get all sign offs I need and the NHS would have collapsed long ago without non-doctor roles stepping up to do what were previously doctor jobs."

I was making a general point, not referring to one specific poster.

Reply 16

InArduisFouette

21

Original post by No_fixed_abode

That is a shame. I had thought one of the benefits of having physician associates etc. was so that junior docs would have fewer bloods/TTOs etc in order that they could do things like chest drains and get some training.

this is the problem with the whole PA role

ACPs are expert clinicians who offer more than the primary registered qualification , this overlaps significantly with the 'medical domain' , but then again even as a none ENP E grade RN in A+E in the mid 2000s significant chunks of what iI did then would have in the 1980s been considered 'medical' ... never mind what ENPs were doing and then the development of ACP and similar advanced practice Nursing and AHP roles

In the mid 2000s there were some trusts who experimented with 'Doctor's Support Workers' i.e. Band 3 HCSWs whose role was solely to be a bloods / cannula / ecg / male catheter ***** - this was around the time of the original Hospital at night work where OOH everything was going to go through 'clinical coordinators' who were generally RNs by primary registration to be dished out to the relevant worker whether that be a support worker, a support Nurse / Physio etc or to athe relevant grade of Doctor

PAs in the Uk came as medically led grab against Advanced practice Nurses and AHPs as some of the older generation of Doctors considered them to be 'filthy mudbloods' where PAs could be indoctrinated into the sacred ways of medicine ( all sarcasm intended )

Why can’t the medicine areas be more broken down?

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