Patients deserve to know that their health is in the hands of a real doctor
sir – You report (December 11) concern on the part of the British Medical Association and other medical organisations that a “blurring of the roles” of physician associates – who have no formal medical training – and fully qualified doctors could contribute to “a dangerous ambiguity in patient care”.
The Doctors’ Association UK has already found numerous instances of patient harm when associates have undertaken tasks that should have been done by doctors. The General Medical Council is now set to regulate them, but the real question is: should there be physician associates at all?
When patients arrive at a surgery, will they be seen by a physician associate with two years’ training or a real doctor with many? Will patients be told? Will they get a choice?
You report that associates will not undertake tasks that only doctors are qualified to do. So, who will judge whether their condition merits seeing a doctor rather than an associate?
What seems to be ignored is that a doctor’s ability to recognise whether a patient may have a serious condition only comes from years of examining and dealing with minor symptoms, so as to be able to differentiate between normal and abnormal. With a few obvious exceptions, they shouldn’t be shielded from the apparently trivial.
The Government’s envisaged “massive expansion” of physician associates will further erode primary care.
Dr Stefan Slater
Edinburgh
sir – The rise of physician associates is not the first initiative to blur the identity of who exactly is providing healthcare.
When I was a newly qualified doctor, nurses wore different uniforms and caps, so you could tell from the other end of the ward whether someone was a sister, state registered nurse, state enrolled nurse, student nurse (and in which year of training) or an auxiliary nurse.
Many hospitals now have the same uniform for everyone, so only a small badge will tell you who you are speaking to. This allows the wards to look better staffed than they are; if there is only one qualified nurse on duty, working with healthcare assistants, this will not be obvious to the casual observer.
Dr Hilary Aitken
Kilmacolm, Renfrewshire
sir – I spent 50 years as a registered pharmacist. My qualification involved three years at university followed by another year to enable registration as a member of what was then called the Pharmaceutical Society of Great Britain, which provided regular inspections of practice competence. This qualification had to be on display. Terms such as “physician associate” or “clinician” offer no assurance of the standards of advice on offer.
MJ Shucksmith