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    (Original post by Ciaran88)
    I didn't do A&E but I've heard it's a lot more hands on and requires you to learn a lot more.

    Medicine & surgery are usually just scut-fests. Even on calls, you're just filling in a clerking proforma, no time to think about the patient just fill it in ASAP then move on to the next one.
    That wasn't really my experience of medicine or surgery either - in both I learnt an awful lot about the practicalities of managing a wide variety of conditions (admittedly in between the scut work). I guess things might vary from hospital to hospital - I was in a middle sized DGH and I wouldn't be surprised if your hospital was either a teaching hospital or a busy large DGH based on your experiences.
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    (Original post by Captain Crash)
    That wasn't really my experience of medicine or surgery either - in both I learnt an awful lot about the practicalities of managing a wide variety of conditions (admittedly in between the scut work). I guess things might vary from hospital to hospital - I was in a middle sized DGH and I wouldn't be surprised if your hospital was either a teaching hospital or a busy large DGH based on your experiences.
    I was in a medium-small DGH.

    The issue was almost 100% down to understaffing as far as I could tell. The regions main tertiary hospital was often on divert to us and we were taking more patients than we were designed for already, so on call shifts were usually hectic.

    It boiled down to filling out a clerking proforma as fast as humanly possible, scribbling the patients name on a list and moving on to the next one, a Reg/Consultant would come along later and do all the actual medicine. Theoretically we were supposed to be with them to get some teaching when they did, but in practice when you're in a hospital that is running at 50% of what was considered "bare minimum" number of doctors, it doesn't happen.

    NHS pen pushers would probably say it's up to us to go and check back on those patients the next day, "look up their case report on EzNotes!" etc. but of course in reality it meant that you learnt nothing from the majority of patients you saw.

    I get the impression that the West Midlands has a particular issue with staffing levels but I would expect it's similar in the rest of the country, and if not, it will be. They are cutting back on F1 posts in my hospital next year.

    The mind boggles.
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    It might have been just how your hospital worked. That seems very odd to me.

    In those I have worked in for medicine or surgery, you have to clerk, do all the tests and then present a finish piece of work to the consultants either in a post take round or a handover meeting to the team.

    I have never heard of fy1 filling in a clerking proforma then waiting for a senior to initiate a plan. Surely if the patient came as a referral from a&e there is no point clerking without doing a full management and investigation plan ? Seems a bit odd to me.
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    (Original post by Revenged)
    It might have been just how your hospital worked. That seems very odd to me.

    In those I have worked in for medicine or surgery, you have to clerk, do all the tests and then present a finish piece of work to the consultants either in a post take round or a handover meeting to the team.

    I have never heard of fy1 filling in a clerking proforma then waiting for a senior to initiate a plan. Surely if the patient came as a referral from a&e there is no point clerking without doing a full management and investigation plan ? Seems a bit odd to me.
    We would put a basic plan in place. Simple meds, order some imaging etc. but that's it.

    As far as I can tell bedside teaching has basically ceased to exist here. Every ward round is a business round, every on call is understaffed, so it's just about robotically performing your tasks as fast as possible.

    The new NHS Chief Exec said as much, but I doubt he'll be able to reverse it. These changes have all been led by money and money trumps everything else.
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    (Original post by Carpediemxx)
    You misunderstood, phleb do bloods only where I am
    There are nurse practitioners in various specialties, most are very useful and appropriate like asthma nurses or diabetic nurses
    Surgical nurse practitioners depend on the specialty but cardiothoracic surgery for example they will pre op and harvest leg veins in theatre
    They do nothing on the ward and also do not do anything like the junior doctor role

    This plan will never ever work
    in a previous hospital i have worked at, just as i was leaving, they were cutting ortho sho jobs and replacing them with physician assistants on the wards. these PAs were expected to do the work of the ortho SHO. bearing in mind that in ortho you were basically meant to just get on with things by yourselves - do your own ward round and the jobs. your regs/consultants would only see their patients once a week. how can someone who hasn't been to medical school do this?! another problem is they can't prescribe, which means they had to get in a prescribing pharmacist. i don't fully understand how someone can prescribe a drug if they haven't assessed the patient medically.

    i heard there was a death in a young man from multi organ failure sepsis after coming in with a closed fracture at a weekend a PA was covering. nothing is one person's fault, but it interesting to think that if they had a medically trained junior doctor on the wards, would the scenario have been different?

    i do see the potential benefits of PAs, especially in surgical specialties where patients aren't too 'medically' unwell. They probably will not rotate as often and will be able to learn all the nuances of that specialty and the consultant's preferences, but they still aren't medically trained, and anyone can develop a medical problem whilst in hospital.
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    (Original post by blueandpink)
    in a previous hospital i have worked at, just as i was leaving, they were cutting ortho sho jobs and replacing them with physician assistants on the wards. these PAs were expected to do the work of the ortho SHO. bearing in mind that in ortho you were basically meant to just get on with things by yourselves - do your own ward round and the jobs. your regs/consultants would only see their patients once a week. how can someone who hasn't been to medical school do this?! another problem is they can't prescribe, which means they had to get in a prescribing pharmacist. i don't fully understand how someone can prescribe a drug if they haven't assessed the patient medically.

    i heard there was a death in a young man from multi organ failure sepsis after coming in with a closed fracture at a weekend a PA was covering. nothing is one person's fault, but it interesting to think that if they had a medically trained junior doctor on the wards, would the scenario have been different?

    i do see the potential benefits of PAs, especially in surgical specialties where patients aren't too 'medically' unwell. They probably will not rotate as often and will be able to learn all the nuances of that specialty and the consultant's preferences, but they still aren't medically trained, and anyone can develop a medical problem whilst in hospital.
    Wow, genuinely awful stuff. I really hope you reported these concerns as untrained people should not be on sho rota especially if they are causing death through negligence. I am surprised your orthopods tolerated this.
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    (Original post by Revenged)
    Wow, genuinely awful stuff. I really hope you reported these concerns as untrained people should not be on sho rota especially if they are causing death through negligence. I am surprised your orthopods tolerated this.
    that incident happened after I left, but i know there was a big investigation into it. It will mean that the registrars and consultants who are on with these PAs need to be more on the ball to compensate. Because PAs seem, on the surface, to be a good quick fix to the lack of ortho SHOs on the rota, I'm not sure they're going stop having PAs soon.


    The last hospital i was at has just appointed its first general surgical PA as they are starting to make adjustments for reduction of F1s into community placements. It's going to become more and more common.
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    (Original post by blueandpink)
    in a previous hospital i have worked at, just as i was leaving, they were cutting ortho sho jobs and replacing them with physician assistants on the wards. these PAs were expected to do the work of the ortho SHO. bearing in mind that in ortho you were basically meant to just get on with things by yourselves - do your own ward round and the jobs. your regs/consultants would only see their patients once a week. how can someone who hasn't been to medical school do this?! another problem is they can't prescribe, which means they had to get in a prescribing pharmacist. i don't fully understand how someone can prescribe a drug if they haven't assessed the patient medically.

    i heard there was a death in a young man from multi organ failure sepsis after coming in with a closed fracture at a weekend a PA was covering. nothing is one person's fault, but it interesting to think that if they had a medically trained junior doctor on the wards, would the scenario have been different?

    i do see the potential benefits of PAs, especially in surgical specialties where patients aren't too 'medically' unwell. They probably will not rotate as often and will be able to learn all the nuances of that specialty and the consultant's preferences, but they still aren't medically trained, and anyone can develop a medical problem whilst in hospital.
    Interesting point in bold. I'm rotating through surgical admissions at some point in the next few months and they've just introduced a medical consultant and medical SHO to the team purely to look after the patients from a medical viewpoint.
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    Is it not illegal for non trained doctors to be on an SHO rota ?

    I worked with PA's in medical admissions and really they only did donkey work - clerking without prescribing, bloods and discharged letters. Although they were not very competent they were always around medics so we cover for any short comings. I do not think they are trained to be independent and defo should not be on SHO rota or leading ward rounds independently. If such a case went to court, which it would if it were my relative, the hospital will be liable to a heavy negligence claim.

    I would just leave surgery ASAP mate. Dying specialty. Radiology you get much better training and you will never have to deal with this.
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    (Original post by Revenged)
    If such a case went to court, which it would if it were my relative, the hospital will be liable to a heavy negligence claim.
    The attending physician is responsible for PA's in the US so I assume PA's will have a named consultant in the UK who would be ultimately accountable for them within reason?
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    (Original post by Revenged)
    I would just leave surgery ASAP mate. Dying specialty. Radiology you get much better training and you will never have to deal with this.
    You come across as speaking from experience (?).

    Sadly I've met enough jaded former surgical CTs/STs for it not to matter.
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    I never even considered surgery as a career. Never ever ever ever ever ever. It was always a never option.

    This is not the point, however bad the training the fact they have replaced SHO surgical housemen with untrained professional is something very worrying, especially when they are filling oncall gaps or leading ward rounds independently. This is just dangerous.

    I would be interested if anyone knows the legal position on this and how this is allowed.
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    (Original post by Revenged)
    I never even considered surgery as a career. Never ever ever ever ever ever. It was always a never option.

    This is not the point, however bad the training the fact they have replaced SHO surgical housemen with untrained professional is something very worrying, especially when they are filling oncall gaps or leading ward rounds independently. This is just dangerous.

    I would be interested if anyone knows the legal position on this and how this is allowed.
    I know some NICUs have ANNPs on the SHO or even reg rota! But I get the feeling that's a lot more procedural and protocolised than a surgical ward could ever be. I would not want a member of my family cared for by a PA.

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    (Original post by Caponester)
    The attending physician is responsible for PA's in the US so I assume PA's will have a named consultant in the UK who would be ultimately accountable for them within reason?
    I really do not think an orthopod is going to take accountability for clinical errors made by a PA. It must be the PA that will be responsible for their own mistakes or the trust for employing untrained professional to senior positions.
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    (Original post by Helenia)
    I know some NICUs have ANNPs on the SHO or even reg rota! But I get the feeling that's a lot more procedural and protocolised than a surgical ward could ever be. I would not want a member of my family cared for by a PA.

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    What is NICU and ANNP ? Nurse practitioner as itu registrar ???
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    (Original post by Revenged)
    What is NICU and ANNP ? Nurse practitioner as itu registrar ???
    Neonatal intensive care unit/advanced neonatal nurse practitioner.

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    (Original post by Revenged)
    I really do not think an orthopod is going to take accountability for clinical errors made by a PA. It must be the PA that will be responsible for their own mistakes or the trust for employing untrained professional to senior positions.
    The exact wording from a document produced by their voluntary professional body is

    It is envisaged that supervising doctors will be accountable overall for the work of the Physician Assistant, in a similar manner to their responsibilities for trainee doctors, non- consultant career grade doctors, staff and associate specialist grade doctors. Individual Physician Assistants will still be accountable for their own practice, within the boundaries of supervision and defined scope of practice. Supervising clinicians must accept overall responsibility for any duties that are undertaken by a Physician Assistant in training or a qualified Physician Assistant. On this basis, doctors should determine the scope of duties and responsibilities of the Physician Assistant on the basis of known competence within the relevant area of practice.

    So It's probably very similar to what would happen if a junior made an error. Accountable but with a pinch of salt?
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    Interesting. Medical consultant are normally good at supporting juniors but surgeons and orthopods less so. I think it is a grey area with nurse specialists and PA working in doctors roles. Sometimes they are appropriate but sometimes very inappropriate.

    My concern with the changes is mostly selfish. I really share helenia concerns with unqualified PA in doctors shoes but this mostly is because my dad is scheduled for a hip replacement. I think I am going to take my annual leave to monitor him post op since I can't be sure that the hospital he is having it is staffed with assistants and the story above has worried me a lot.

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    (Original post by Revenged)
    I really do not think an orthopod is going to take accountability for clinical errors made by a PA. It must be the PA that will be responsible for their own mistakes or the trust for employing untrained professional to senior positions.
    On a similar note, there a nurse practitioners with their own theatre lists e.g. ortho have them doing carpal tunnels unsupervised, with the consultant next door if there are any problems. The consultant would be held accountable for anything, same as if the registrar were to do the list alone.
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    (Original post by blueandpink)
    On a similar note, there a nurse practitioners with their own theatre lists e.g. ortho have them doing carpal tunnels unsupervised, with the consultant next door if there are any problems. The consultant would be held accountable for anything, same as if the registrar were to do the list alone.
    I have anaesthetised for a NP doing transperineal prostate biopsies under GA. At one point she was being filmed as part of a teaching course on the procedure for urology trainees.

    When my husband had to have a bone marrow aspirate and biopsy (under local, but still pretty unpleasant!) I asked the haem SpR about it and he recommended that we got it done by the NP as she was more experienced than the SpRs at it.

    I have less of a problem with things like this, where they are highly trained to do one or two specific procedures (although I suppose there is the issue that they may be taking away training opportunities from doctors), and know who to call if things go wrong, than with them being responsible for a ward full of patients. Having a BM biopsy by an NP is fine, but if my husband had ended up with neutropaenic sepsis from his chemo, I'd be wanting a haematologist!
 
 
 
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