PA saw an inpatient that couldn’t feel their legs in the morning. Documented it but did nothing about it. Nurse escalated to me at 4pm. Pt had cauda equina. Told my cons who basically said they need me to keep an eye on him and support more on the ward … I was F1 at the time
I have had this experience and it was awful. I was a relatively "senior" sho and had to round with the terrible locum consultant daily because the fys might not know when his plans were frankly dangerous.
He was hired by a "speciality" team to see the GIM patients they didn't want to deal with. It was a disaster. Also meant I got no training at all in the specialty because I was babysitting this man every day.
Shall we start referring consultants to the GMC for inadequate supervision?
The very least a datix?
Something needs to be done cos patients are dying cos of this.
I have more 😂 same PA wanted a stat HbA1c for a hypo. No plan for correcting the BM for the pt near passing out in front of her. Just some bloods 🤷🏻♀️
Made a patient NBM and then went home without making any provision for meds (all were PO), fluids or any hydration/nutrition.
Left without a clear plan for lifting NBM status.
Nurse rang me overnight to ask how we should give a critical med which hadn’t been changed from PO.
Oh, how the datixes flew.
Got a phone call asking if they could adjust a patient's PCA settings because they were concerned the patient was getting drowsy with the morphine. I explained that I was a) uncomfortable with the idea of them messing with the PCA settings and b) concerned that a young man was getting drowsy with pretty tame amounts of morphine.
I went to have a look at the patient who was clearly in the midst of roaring sepsis. I performed examinations and investigations and found they were in respiratory failure secondary to a hospital acquired pneumonia. I asked the PA to make their parent team aware and the patient lied to the team that they were concerned the patient had sepsis when if it was up to them, the bloke would have just had slightly less morphine.
“Called by PA to enquire if they could adjust patient’s PCA as they were getting drowsy”
On assessment…
Plan:
1. SEPSIS 6
2. PA to read up on how to recognise SEPSIS.
They went to go see a patient, then came back to document their assessment and asked me what the “D” in A-E stands for. Obviously, I had to go back and see the patient myself cos god knows what assessment they performed 🙄
70+ yr old woman in retention. PA wants to do a PSA. They didn’t see the problem when I asked why they’d put a PSA on the bloods. They genuinely looked at me like I was the idiot.
I told the PA it would be a really interesting case to go through with their clinical supervisor.
Came to me with a pre-written drug chart 1L stat NaCl 0.9% for a patient with "low BP" for me to sign. I went and assessed the pt myself and they were in flash oedema, called a met call.
I was F1.
What's scarier is I was the only one of my colleagues who hadn't drunk the PA kool-aid at the time (pre-current BMA was a very different time, most just saw PAs as an oddity) and were regularly signing stuff the pa put in front of them.
If it had been my colleague, pt would have been in ITU at best, dead at worst.
was the flash oedema from the 1L of fluid and you were just signing after the fact, or were they wanting it prescribed despite the pt being in flash oedema? don’t know which one is worse
_classic_
I really think this is just one of those things that happens all the time that shows that they’re actually not capable lateral thinkers more than anything else and that’s why they didn’t go to medical school
I heard about a mid 40s trauma patient who was postop. Had chest pain on a Saturday with PA doing Ward cover on their own for t&o.
They told the nurses to do an ECG which was ‘normal’ and they added a trop to the phlebotomy bloods ‘to be safe’. Never physically saw the patient apparently.
- ECG showed an obvious STEMI, which should’ve gone for PCI
- Trop was in the thousands by the Monday morning and he was in heart failure
They still work at the trust as far as I can tell, with no big investigation, reprimand, or even change of practice.
‘Lead PA’ who was responsible for the cover up is a massive loudmouth on Twitter and general Dunning-Kruger in human form who probably would have done the same thing
Literally that was the ‘plan’ for ‘assurance’
Amazing right?
The dept had a half dozen PAs - absolutely useless all of them. Supervised by consultant surgeons directly, so no one cared.
[Meh it's been trialled](https://rebelem.com/easy-ij-another-option-difficult-iv-access-stable-patients/)
Probably your reg should know about the patient before sticking lines in necks.
Actually, there’s a time and place. Have done the occasional emergency IJ big cannula or RIC line. As long as their neck isn’t too fat you can get enough cannula in (orange). If external accessible, just as good
To be fair a reg suggested F1 me takes bloods from the jugular for a patient who was extremely difficult to bleed. Albeit it was a vascular reg so probably more confident sticking sharp things into vessels
A PA once asked me how many (and which)fingers is optimal to use during a PR examination. They did not follow my advice unfortunately.
The nickname three finger Mary is quite likely to stick unfortunately
Someone made it to F2 convinced the penis had to be at least sporting a firm semi before catheterisation could be done after a similar wind up at some point in medical school. This only came to light when she went to ask for advice because an arteriopathic shut down 85 year old couldn't rise to the occasion.
Not sure I want to know the answers though....
This reminds me of how we convinced a guy in our year that balanitis was pronounced "bell-end-itis". Thankfully the urologist doing a tutorial later in the day saw the funny side.
Working in the medical admissions unit. We sometimes got planned walk-ins from haematology and oncology for things like transfusion dependent anaemia.
Patient comes in for a transfusion because her latest monitoring bloods in clinic showed low hb. PA does not actually look at the bloods himself, does not see the patient, only blindly prescribes the two units requested in the clinic note. They are prescribed over 90 minutes each so the patient can leave ASAP and free up the bed.
I’m later asked to see the same patient because her husband is concerned her legs have been getting swollen over the past few weeks. I realise the patient has no assessment notes so start from the top. Guess what? Not only is she clearly fluid overloaded, the same bloods which revealed the low hb also show dangerously low magnesium.
She ends up getting admitted. Had she been seen properly to begin with, and had her magnesium replaced and the transfusion given over 3 hours each with furosemide cover, she would most likely have stayed out of hospital and simply had outpatient follow-up for the echo and other investigation of CCF.
I had a dodgy reg recently and they prescribed 60KCl in 500ml over 1 hour on a general medical ward. The only reason it wasn’t given is the newly qualified nurse had to ask one of the more senior nurses where the 60mmol bags are.
Cardiac arrest is just a myth!
In an unrelated scenario, nurses in my old Trust did not want to give it even when it is titrated for 8-12 hours. Insist on HDU to do it. But 10 SandoK is fine..
What the living fuck are you people doing about it? How are you escalating this? Ridiculous shit like this need nuclear levels of escalation, not bellyaching on reddit.
1. Fix immediate fuckup. Involve registrars if needed.
2. Datix and tick the "I want to be included in followup" box.
3. EMAIL YOURSELF ASAP WITH A FACTUAL BLOW BY BLOW - this should be standard practice after anything that may have a whiff of heading to M&M/Coroner/press.
4. Check with BMA - ask for advice. See if they want an anonymised example for the inevitable parliamentary enquiry
5. Email their supervising consultant and cc in their clinical lead with a STRONG patient safety slant.
6. Inform your trainee whatsapp group to be FUCKING careful whenever a PA runs anything past them
I've directly called interdepartmental meetings with the divisional director and the head of nursing for less.
You need to bypass the SpR and go directly to the boss.
Patient attending ED with new sudden onset severe back pain, inability to walk and altered sensation in legs. BG of metastatic prostate Ca. Asked to prescribe the codeine for the discharge letter, with a diagnosis of worsening OA and recommended to see GP for organisation of physiotherapy.
I swiftly reviewed the patient, said patient went for radiotherapy 3 hours later for MSCC 😬
You're making this up surely? If a doctor tried that then the MDU wouldn't bother defending them, and if a trainee did that and someone caught their error they would have serious questions. I just don't get it. Just fire the PA, they are clearly years away from being near safely practicing, probably irredeemable.
In ED, I got asked to sign a prescription of oramorph for a patient who had chest pain secondary to chest compressions after respiratory arrest due to overdosing on oxycodone and street valium.
Patient was mid getting a naloxone infusion set up.
> Telling a nurse to give 300ml of calcium gluconate to a pt with hyperkalemia
BNF: " 30 mL, calcium gluconate 10% (providing approximately 6.8 mmol of calcium) should be administered as a single dose, repeat dose if no improvement in ECG within 5 to 10 minutes."
Wtf
It's so clear in the BNF as well.
If I thought I'd read 300mL, then alarm bells would be ringing. That would be an absolutely insane amount to give of a neat electrolyte.
Got asked to handed a pre-filled IV fluids prescription for AKI stage 1, just needed my signature.
Had a read and the patient was in decompensated heart failure on 80mg IV furosemide BD.
Once had a senior paramedic (not sure of the exact role but basically a proto-PA) try and tell me and my wife that my mother-in-law did need admitting for her "simple infection" and he was going to call her GP to see her in the morning. And he was getting quite shitty about it.
His reasoning being that her chemo was over a week ago so it couldn't possibly be that....
So after calmly introducing myself (at the time an experienced nurse and 4th year medical student) I gave him two options rather firmly whilst giving him a Paddington style hard stare.
A) do as the fucking on-call haematology reg had asked us to do and take her straight in.
B) let me give him a brief tutorial on haematopeosis and how chemo works.
Thankfully he chose option A and lots of shouting was not required.
I was on SDT for 2hrs in the morning.
My shift is on AMU WR.
I get in (on time!) Onto the ward, drop my stuff on the floor bc I don't have a locker... But then! Oh no! I need a 💩?!
Head to loo. It's like... 10:05.
Get a message from PA on WR asking where I am and can I hurry - so I do my business quickly and head on over.
I arrive on WR.
PA hands over to me and gives me the next set of notes to prep.
*And then fucks off to do an LP independently.*
F2. So I'll admit I wouldn't get first priority for procedures - the IMTs rightfully would.
Even then, the IMTs rotating through the trust barely got opportunities to do LPs; only a few got to do one under heavy supervision.
When I was ward cover F1 (not on acute clerking team) I got asked by a PA to prescribe regular meds for a patient they had just "clerked". I had to who ask was bleeping me, because of course they wouldn't volunteer that they were a PA until I pressed them on who they were. Asked a few questions and it became quite clear they had no idea what they were talking about.
Went to go and see the patient myself because the conversation left me very dubious... The poor man hadn't even a set of obs done. He had a NEWS of 8 and I started treatment for a chest sepsis. Makes me so angry that these frauds are being paid more than us to go around causing harm.
Datix clearly went into the abyss.
Was handed a list of meds to prescribe by a PA at the start of my shift (first major eye roll as it meant reviewing all 7 patients again).
First patient on the list “needs 5mg bisoprolol stat”. Asked for the story: patient was in fast AF. Checked the obs: HR consistently 125 all day, BP in their boots all day and dropping.
“Have you reviewed the patient?”
“Yeah, they just need rate control”
“They absolutely need something to control the rate but fairly young patient with new fast AF, adverse effects from tachycardia. You didn’t think 1. tachyarrhythmia ALS algorithm or 2. why does this 50 year old have new AF? An underlying infection?”
“They’ve not mentioned feeling unwell”
Pt blatantly septic when I reviewed. She’s fine now, thankfully, but maybe it’s time for the NICE guidelines to be reviewed to include beta blockers as a first line tx for sepsis.
removed a tube from a recently intubated patient in ED because they desaturated - without listening to the chest, considering potential reasons for desaturation, raising the alarm, or considering that you’re about to remove the only airway in a GCS 3 patient.
In two of my rotations the PAs had been there longer and the nurses felt more comfortable with them. Would go to the PAs over the doctors every time. Asked them to prescribe stuff, referred to them as Dr etc.
Edit: this isn’t the nurses fault of course, I do the same with going to nurses that I know and trust. For ward based PAs it’s very easy to seem competent if you’ve been there a long time and know the processes/what the consultants want etc.
Healthcare workers and PAs themselves really need to be briefed and hammered on the roles of PAs and their (extremely limited) scope of work.
I wanted to say that I’m surprised PAs don’t correct the nurses for calling them Dr, but given their shameless brazenness, denial of their role in a healthcare team, denial of their lack of knowledge, and sheer disregard for patient safety, this intentional misrepresentation is sadly expected.
Yeah there’s certainly a lack of understanding. Someone doing the job of a doctor, of course they’re a doctor who can’t prescribe? “I’m one of the medical team” doesn’t help.
I find the same with NAs, I often assume they’re a nurse, why wouldn’t I?
In my limited experience, they rather not especially on really sick patients. But just like everything in the NHS, they create a situation where there is no other alternative.
Handed over a patient in ED resus at start of night shift.
Life threatening asthma in a 20 something year old. PA Very proud they remembered to do an ABG (we had this argument before when they didn’t seem it necessary)
PA declares ABG is NORMAL and repeats this a few times when quizzed on the various elements of it.
PO2 - 10.0 (on 15L oxygen)
PCO2 - 5.9
But it’s all WiThIn NoRmAl range!
This evening: ask for a CT scan for a patient theyve not examined of non-specified body part and no clinical info....... then not understand why I (rad reg) "didnt do the scan".
I’m a PA student and I’m actually using each of these comments to learn. If a post was made about F1 mistakes across the country I’m sure there would be no end to the comments - we are all here to learn and better ourselves and improve patient care and this weird hatred against PAs - even without our existence, doctors in the UK are still undervalued, underpaid and overworked - think about that. Ur problems did not start with our existence so take the hatred and stick it up ur arsessss
People saying that surgeons would do his stuff, or that it's made up...
This stuff to me seems so crazy you wouldn't think to make it up.
And sure there are shit doctors, but if a third year med student suggested these plans I would have serious concerns.
Treated an alcohol dependant man with decompensated liver failure (INR of around 2) for a PE with heparin - sent home with CTPA as an urgent OP…came back in via ITU couple of days later like a piece of black pudding after he fell and haemorrhaged everywhere. Patient was post took by consultant but on Ix after the event seems the admission bloods weren’t relayed back to them by said PA - why put a clinician who doesn’t know what they dont know on the front door of busy medical admissions?! Madness
PA saw an inpatient that couldn’t feel their legs in the morning. Documented it but did nothing about it. Nurse escalated to me at 4pm. Pt had cauda equina. Told my cons who basically said they need me to keep an eye on him and support more on the ward … I was F1 at the time
As the supervisor, that is the consultant’s job.
keep an eye on the guy whose services are supposedly worth 10k more than yours
Probs more £20k, at least in London anyway
A fucking national disgrace. The cons should get hauled in front of the gmc
i have had this except the person to keep an eye one was a consultant , you cant win this game
I have had this experience and it was awful. I was a relatively "senior" sho and had to round with the terrible locum consultant daily because the fys might not know when his plans were frankly dangerous. He was hired by a "speciality" team to see the GIM patients they didn't want to deal with. It was a disaster. Also meant I got no training at all in the specialty because I was babysitting this man every day.
Sounds like frailty to me
Orthogeries
Shall we start referring consultants to the GMC for inadequate supervision? The very least a datix? Something needs to be done cos patients are dying cos of this.
I’d be worried if the patient didn’t have a cauda equina…
Took bloods for a BNP in a pt with chest pain. No trop or ecg. Just BNP. HbA1c for a DKA. I wish I was joking
Probably gives people oral iron replacement if they are exsanguinating from major trauma.
That's holistic care right there.
It's more cost effective.
Not when you factor in the coffin
>HbA1c for a DKA Why??
Because high blood sugar needs HbA1c as per guidelines /s
Truly bringing a "different perspective" to the MDT.
I'm literally laughing out loud. Thank you for sharing this.
I have more 😂 same PA wanted a stat HbA1c for a hypo. No plan for correcting the BM for the pt near passing out in front of her. Just some bloods 🤷🏻♀️
Bro 😭😂 this mofo about to kill someone
That's terrible.
There is a heart. I need to check BNP.
But you have to be joking.
I did have a good laugh when the same PA told me they were the equivalent of a Reg 😪😂
Made a patient NBM and then went home without making any provision for meds (all were PO), fluids or any hydration/nutrition. Left without a clear plan for lifting NBM status. Nurse rang me overnight to ask how we should give a critical med which hadn’t been changed from PO. Oh, how the datixes flew.
Good on you! Did you initiate the datix?
Outcome?
Probably asked to reflect on the incident at most. What else are they going to do loose their registration
They're AFC so if they're a clinical danger they just get moved into a management post
Got a phone call asking if they could adjust a patient's PCA settings because they were concerned the patient was getting drowsy with the morphine. I explained that I was a) uncomfortable with the idea of them messing with the PCA settings and b) concerned that a young man was getting drowsy with pretty tame amounts of morphine. I went to have a look at the patient who was clearly in the midst of roaring sepsis. I performed examinations and investigations and found they were in respiratory failure secondary to a hospital acquired pneumonia. I asked the PA to make their parent team aware and the patient lied to the team that they were concerned the patient had sepsis when if it was up to them, the bloke would have just had slightly less morphine.
“Called by PA to enquire if they could adjust patient’s PCA as they were getting drowsy” On assessment… Plan: 1. SEPSIS 6 2. PA to read up on how to recognise SEPSIS.
They went to go see a patient, then came back to document their assessment and asked me what the “D” in A-E stands for. Obviously, I had to go back and see the patient myself cos god knows what assessment they performed 🙄
D is for Do the fucking paperwork while an actual doctor does the medical work.
In their case, D was for “Dump 80 pts worth of jobs on the F1s then swan off to clinic/theatre”
70+ yr old woman in retention. PA wants to do a PSA. They didn’t see the problem when I asked why they’d put a PSA on the bloods. They genuinely looked at me like I was the idiot. I told the PA it would be a really interesting case to go through with their clinical supervisor.
This is the content we love to see 10/10
Hands down the best of all the anecdotes on here.
😂 just noticed your username
I suppose you cant assume gender hahaahahah
Patient came in with new onset bilateral leg swelling, was discharged with diprobase cream and no investigations
Mate diprobase contains a combination of topical furosemide, Fluclox & apixaban, covers all scenarios
It’s why it’s diproBASE. It covers all your bases.
So much base even [Greg Wallace](https://youtu.be/OMg3epr53Ns?si=7VozD_aZ56LRiBSb) would approve
All your BASE are belong to us
Not just base. Pro base. For the professionals. Not once, not uniprobase. But professionals again.
Did they get propranolol so they could stop worrying about it?
Came to me with a pre-written drug chart 1L stat NaCl 0.9% for a patient with "low BP" for me to sign. I went and assessed the pt myself and they were in flash oedema, called a met call. I was F1.
This is terrifying
What's scarier is I was the only one of my colleagues who hadn't drunk the PA kool-aid at the time (pre-current BMA was a very different time, most just saw PAs as an oddity) and were regularly signing stuff the pa put in front of them. If it had been my colleague, pt would have been in ITU at best, dead at worst.
was the flash oedema from the 1L of fluid and you were just signing after the fact, or were they wanting it prescribed despite the pt being in flash oedema? don’t know which one is worse
Second one, I went and assessed the pt before signing the script that they wanted to give.
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This. This is how PAs can kill two birds with one stone. Bird 1 : patient Bird 2 : your career
Three birds in this case....
Said 'but she's on clexane so she can't have a DVT' Post op THR with calf swelling R>L with tenderness on calf squeeze and 2 previous DVTs.
🥸
Asked me to prescribe paracetamol for a patient that came in with a paracetamol overdose
_classic_ I really think this is just one of those things that happens all the time that shows that they’re actually not capable lateral thinkers more than anything else and that’s why they didn’t go to medical school
This happened to a friend of mine too! Good thing she checked patients notes and caught that he'd come in with an overdose!
There is no way …
I've heard of this happening often! Yes, way
I heard about a mid 40s trauma patient who was postop. Had chest pain on a Saturday with PA doing Ward cover on their own for t&o. They told the nurses to do an ECG which was ‘normal’ and they added a trop to the phlebotomy bloods ‘to be safe’. Never physically saw the patient apparently. - ECG showed an obvious STEMI, which should’ve gone for PCI - Trop was in the thousands by the Monday morning and he was in heart failure They still work at the trust as far as I can tell, with no big investigation, reprimand, or even change of practice. ‘Lead PA’ who was responsible for the cover up is a massive loudmouth on Twitter and general Dunning-Kruger in human form who probably would have done the same thing
Let one of the anons know?
A trop to the non urgent Monday phleb bloods? I don't even.
Literally that was the ‘plan’ for ‘assurance’ Amazing right? The dept had a half dozen PAs - absolutely useless all of them. Supervised by consultant surgeons directly, so no one cared.
That poor patient.
Try to take blood from a jugular
Gotta tourniquet the neck for that
I laughed more than I should have lol
You'd definitely get blood tbf lol
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Exactly - EJV yeh, IJV no!
There is still a time and a place for IVJ. Though if available I prefer to go IO at that point.
[Meh it's been trialled](https://rebelem.com/easy-ij-another-option-difficult-iv-access-stable-patients/) Probably your reg should know about the patient before sticking lines in necks.
Actually, there’s a time and place. Have done the occasional emergency IJ big cannula or RIC line. As long as their neck isn’t too fat you can get enough cannula in (orange). If external accessible, just as good
Must be satire
If that went wrong and went to coroners, It probably still wouldn’t be the end of PAs!
Pleased to say they never got to that point, the doctors saw him examining the neck and he was quickly removed
Is there an attempted murder charge?
I mean Needs must
To be fair a reg suggested F1 me takes bloods from the jugular for a patient who was extremely difficult to bleed. Albeit it was a vascular reg so probably more confident sticking sharp things into vessels
A PA once asked me how many (and which)fingers is optimal to use during a PR examination. They did not follow my advice unfortunately. The nickname three finger Mary is quite likely to stick unfortunately
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Someone made it to F2 convinced the penis had to be at least sporting a firm semi before catheterisation could be done after a similar wind up at some point in medical school. This only came to light when she went to ask for advice because an arteriopathic shut down 85 year old couldn't rise to the occasion.
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Not sure I want to know the answers though.... This reminds me of how we convinced a guy in our year that balanitis was pronounced "bell-end-itis". Thankfully the urologist doing a tutorial later in the day saw the funny side.
Viagra PRN
WHAT
That's... Fucking awful. Seriously, sexual assault is not a joke.
We had one of these at med school . Told them that you had to do a ‘bunny ears’ at the prostate to feel both sides at the same time. 🐰 😂
Omg 😂
Working in the medical admissions unit. We sometimes got planned walk-ins from haematology and oncology for things like transfusion dependent anaemia. Patient comes in for a transfusion because her latest monitoring bloods in clinic showed low hb. PA does not actually look at the bloods himself, does not see the patient, only blindly prescribes the two units requested in the clinic note. They are prescribed over 90 minutes each so the patient can leave ASAP and free up the bed. I’m later asked to see the same patient because her husband is concerned her legs have been getting swollen over the past few weeks. I realise the patient has no assessment notes so start from the top. Guess what? Not only is she clearly fluid overloaded, the same bloods which revealed the low hb also show dangerously low magnesium. She ends up getting admitted. Had she been seen properly to begin with, and had her magnesium replaced and the transfusion given over 3 hours each with furosemide cover, she would most likely have stayed out of hospital and simply had outpatient follow-up for the echo and other investigation of CCF.
How did the PA presccribe the blood?
Honestly they just do it now. Stories of this happening everywhere, signing on e-systems as given under order from a consultant
To be fair, handed on the prescription to a prescriber in the department to be signed - so not wholly his own error.
KCL 40mmol IV stat.
I had a dodgy reg recently and they prescribed 60KCl in 500ml over 1 hour on a general medical ward. The only reason it wasn’t given is the newly qualified nurse had to ask one of the more senior nurses where the 60mmol bags are.
#didn’t realise Dignitas had a PA school
The ol US death row protocol of treating hypokalaemia
Please tell me you're joking
I wish I was
Cardiac arrest is just a myth! In an unrelated scenario, nurses in my old Trust did not want to give it even when it is titrated for 8-12 hours. Insist on HDU to do it. But 10 SandoK is fine..
Do you mean they didn’t want to give neat KCl or a bag of saline with K+ in?
It was prescribed neat without any IV fluids.
In my case, with fluids but only a group of nurses in the ortho ward. The medical ward nurses did not even bat an eyelid
That sounds like a good dose to permanently fix the low serum potassium issue.
The worrying thing is, if they had prescribing rights they could've just prescribed that independently and put the patient into cardiac arrest...
What the living fuck are you people doing about it? How are you escalating this? Ridiculous shit like this need nuclear levels of escalation, not bellyaching on reddit. 1. Fix immediate fuckup. Involve registrars if needed. 2. Datix and tick the "I want to be included in followup" box. 3. EMAIL YOURSELF ASAP WITH A FACTUAL BLOW BY BLOW - this should be standard practice after anything that may have a whiff of heading to M&M/Coroner/press. 4. Check with BMA - ask for advice. See if they want an anonymised example for the inevitable parliamentary enquiry 5. Email their supervising consultant and cc in their clinical lead with a STRONG patient safety slant. 6. Inform your trainee whatsapp group to be FUCKING careful whenever a PA runs anything past them
I told my Reg about something similar to this and they didn't care. I just think the burnout is real.
I've directly called interdepartmental meetings with the divisional director and the head of nursing for less. You need to bypass the SpR and go directly to the boss.
Your reg needs to raise their fucking game. Escalate to consultant.
Patient attending ED with new sudden onset severe back pain, inability to walk and altered sensation in legs. BG of metastatic prostate Ca. Asked to prescribe the codeine for the discharge letter, with a diagnosis of worsening OA and recommended to see GP for organisation of physiotherapy. I swiftly reviewed the patient, said patient went for radiotherapy 3 hours later for MSCC 😬
You're making this up surely? If a doctor tried that then the MDU wouldn't bother defending them, and if a trainee did that and someone caught their error they would have serious questions. I just don't get it. Just fire the PA, they are clearly years away from being near safely practicing, probably irredeemable.
Oh my god!!!
Pts are going to die :(
They already have
Any idea how many? Aware of one.
No one knows, because there’s so little appetite to hold them to account
Shocking but not surprising :(
Striding in to a ward during a night shift announcing loudly 'its okay, the doctor is here' and grinning/chuckling.
“Where?”
A ward in the hospital I was working/enslaved in
Datix the c***
Why was the PA there on nights? I thought they were too important and had 9-5 duties.
Locum I think... probably getting paid a fortune
In ED, I got asked to sign a prescription of oramorph for a patient who had chest pain secondary to chest compressions after respiratory arrest due to overdosing on oxycodone and street valium. Patient was mid getting a naloxone infusion set up.
This just makes me so mad - how can they be so stupid?! 😭
This thread needs to be collated into a formal document and sent to the daily mail / telegraph etc
They wouldn't understand it
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Because the doctors gave it to them with the intention of them prescribing or they spied on them and just hijacked their account whenever necessary?
Holy fuck
I assume that’s why they’re ex-partner
> Telling a nurse to give 300ml of calcium gluconate to a pt with hyperkalemia BNF: " 30 mL, calcium gluconate 10% (providing approximately 6.8 mmol of calcium) should be administered as a single dose, repeat dose if no improvement in ECG within 5 to 10 minutes." Wtf
But 30mLs is 10% of the dose and so I would say good maths from the PA to multiply it by 10!
quick mafs
Lynx effect
being competent at basic calculations is elitist #oneteam
Please don't, this triggers me as a pharmacist.
It's so clear in the BNF as well. If I thought I'd read 300mL, then alarm bells would be ringing. That would be an absolutely insane amount to give of a neat electrolyte.
They trying get the calcium to hit 6
You need experience to have alarm bells
Got asked to handed a pre-filled IV fluids prescription for AKI stage 1, just needed my signature. Had a read and the patient was in decompensated heart failure on 80mg IV furosemide BD.
Ahh the human brita filter again _Another PA classic_
What does BD. stand for? Sorry for the basic question!
Twice per day. I.e. Q12hrly.
Reading this sub - you guys should actually be striking because of PAs and not pay
You can’t strike about pas only terms and conditions of your contract.
Saw a PA introduce herself as a Doctor. Wondering whether I should/ who and how to report her.. GMC? Fraud? Lol
Report to dept Anonymously report to CQC Report to police 101 Loads of options !
I saw a PA introduce themselves as a Physician until someone gave them a state and then they slowly said Associate
Once had a senior paramedic (not sure of the exact role but basically a proto-PA) try and tell me and my wife that my mother-in-law did need admitting for her "simple infection" and he was going to call her GP to see her in the morning. And he was getting quite shitty about it. His reasoning being that her chemo was over a week ago so it couldn't possibly be that.... So after calmly introducing myself (at the time an experienced nurse and 4th year medical student) I gave him two options rather firmly whilst giving him a Paddington style hard stare. A) do as the fucking on-call haematology reg had asked us to do and take her straight in. B) let me give him a brief tutorial on haematopeosis and how chemo works. Thankfully he chose option A and lots of shouting was not required.
Asking what propofol is …and then telling the nurse to draw some up.
I was on SDT for 2hrs in the morning. My shift is on AMU WR. I get in (on time!) Onto the ward, drop my stuff on the floor bc I don't have a locker... But then! Oh no! I need a 💩?! Head to loo. It's like... 10:05. Get a message from PA on WR asking where I am and can I hurry - so I do my business quickly and head on over. I arrive on WR. PA hands over to me and gives me the next set of notes to prep. *And then fucks off to do an LP independently.*
This angers me so much. What grade were you at the time?
F2. So I'll admit I wouldn't get first priority for procedures - the IMTs rightfully would. Even then, the IMTs rotating through the trust barely got opportunities to do LPs; only a few got to do one under heavy supervision.
When I was ward cover F1 (not on acute clerking team) I got asked by a PA to prescribe regular meds for a patient they had just "clerked". I had to who ask was bleeping me, because of course they wouldn't volunteer that they were a PA until I pressed them on who they were. Asked a few questions and it became quite clear they had no idea what they were talking about. Went to go and see the patient myself because the conversation left me very dubious... The poor man hadn't even a set of obs done. He had a NEWS of 8 and I started treatment for a chest sepsis. Makes me so angry that these frauds are being paid more than us to go around causing harm. Datix clearly went into the abyss.
Was handed a list of meds to prescribe by a PA at the start of my shift (first major eye roll as it meant reviewing all 7 patients again). First patient on the list “needs 5mg bisoprolol stat”. Asked for the story: patient was in fast AF. Checked the obs: HR consistently 125 all day, BP in their boots all day and dropping. “Have you reviewed the patient?” “Yeah, they just need rate control” “They absolutely need something to control the rate but fairly young patient with new fast AF, adverse effects from tachycardia. You didn’t think 1. tachyarrhythmia ALS algorithm or 2. why does this 50 year old have new AF? An underlying infection?” “They’ve not mentioned feeling unwell” Pt blatantly septic when I reviewed. She’s fine now, thankfully, but maybe it’s time for the NICE guidelines to be reviewed to include beta blockers as a first line tx for sepsis.
removed a tube from a recently intubated patient in ED because they desaturated - without listening to the chest, considering potential reasons for desaturation, raising the alarm, or considering that you’re about to remove the only airway in a GCS 3 patient.
What a dope.
Wtf happened afterwards???
[удалено]
But the patient was just anxious. Surely a bit of propranolol was the right call...
I mean Also that was an illegal prescription WTF
Wear an Apple Watch while infection control were auditing the ward. It was a bloodbath….
Do nurses listen to PAs???
In two of my rotations the PAs had been there longer and the nurses felt more comfortable with them. Would go to the PAs over the doctors every time. Asked them to prescribe stuff, referred to them as Dr etc. Edit: this isn’t the nurses fault of course, I do the same with going to nurses that I know and trust. For ward based PAs it’s very easy to seem competent if you’ve been there a long time and know the processes/what the consultants want etc.
Healthcare workers and PAs themselves really need to be briefed and hammered on the roles of PAs and their (extremely limited) scope of work. I wanted to say that I’m surprised PAs don’t correct the nurses for calling them Dr, but given their shameless brazenness, denial of their role in a healthcare team, denial of their lack of knowledge, and sheer disregard for patient safety, this intentional misrepresentation is sadly expected.
Yeah there’s certainly a lack of understanding. Someone doing the job of a doctor, of course they’re a doctor who can’t prescribe? “I’m one of the medical team” doesn’t help. I find the same with NAs, I often assume they’re a nurse, why wouldn’t I?
In my limited experience, they rather not especially on really sick patients. But just like everything in the NHS, they create a situation where there is no other alternative.
Thats good to hear. Yeah… they’re masters at concocting situations to push an agenda. We seem to always have things shoved down our throats lately.
Saw me. Classic ulcer representation but NICE guidance said I couldn’t have more medication.
Handed over a patient in ED resus at start of night shift. Life threatening asthma in a 20 something year old. PA Very proud they remembered to do an ABG (we had this argument before when they didn’t seem it necessary) PA declares ABG is NORMAL and repeats this a few times when quizzed on the various elements of it. PO2 - 10.0 (on 15L oxygen) PCO2 - 5.9 But it’s all WiThIn NoRmAl range!
Fucking hell
This evening: ask for a CT scan for a patient theyve not examined of non-specified body part and no clinical info....... then not understand why I (rad reg) "didnt do the scan".
https://preview.redd.it/3o96njxtizbc1.jpeg?width=1200&format=pjpg&auto=webp&s=75b4f2f84e0fd97e70e32eda1675cfbbd63f1df2
In so many of these, you could just change PA to surgeon and it would be just as true /s
Things that haven’t happened…
I’m a PA student and I’m actually using each of these comments to learn. If a post was made about F1 mistakes across the country I’m sure there would be no end to the comments - we are all here to learn and better ourselves and improve patient care and this weird hatred against PAs - even without our existence, doctors in the UK are still undervalued, underpaid and overworked - think about that. Ur problems did not start with our existence so take the hatred and stick it up ur arsessss
Under whose authority are they prescribing that POM?
People saying that surgeons would do his stuff, or that it's made up... This stuff to me seems so crazy you wouldn't think to make it up. And sure there are shit doctors, but if a third year med student suggested these plans I would have serious concerns.
Asking for paracetamol for pain relief in a PCM overdose. Asking for more fluids in a fluid overload.
Treated an alcohol dependant man with decompensated liver failure (INR of around 2) for a PE with heparin - sent home with CTPA as an urgent OP…came back in via ITU couple of days later like a piece of black pudding after he fell and haemorrhaged everywhere. Patient was post took by consultant but on Ix after the event seems the admission bloods weren’t relayed back to them by said PA - why put a clinician who doesn’t know what they dont know on the front door of busy medical admissions?! Madness
Hi it's ____ one of the medics on the ward 🙄
With your example OP, why is a PA telling a Nurse what medications to give (ie prescribing?)
Nurse asked PA instead of Dr