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I’ve had some of the worst experience with paramedics and ACPs masquerading as duty doctor for GP practices.
There’s no appreciation for unknown unknowns. After seeing 100 LRTIs and 100 ?DVTs some really do think they’ve cracked medicine. Sadly when something slightly out of the ordinary presents it’s left for others to mop up the mess.
Classic noctor.
Reduces medicine to criteria and gets it wrong.
I’ve not see one doctor use a set of criteria to diagnose a chest infection. Yes we use CURB-65 to stratify severity/mortality but not to diagnose it. It’s diagnosed clinically.
Urea 9? Fuck must be a chest infection. No that’s not how it works 😂
Freakingg hate paramedics in my practice. Every 15 minutes he'd ask for another amoxicillin prescription. Can prescribe my ars
Edited to be more civilised
> Can prescribe my ars
Just on that front, I should say that many can indeed prescribe independently (apart from certain CDs), though not all jobs make that a requirement.
It was great. Finally an open and very public example of why this experiment cannot be allowed to continue. No member of the public listening to that came away thinking anything other than they would ask for a doctor.
Nah they can be horrendous. Transplanted from their area of expertise where they're incredible into one they don't know anything about but often carry a massive ego.
One sod in my area who kept trying to refer mechanical back pain to SDEC as if I've got some magical solution that I'm just keeping from them.
It might not take a lot to diagnose a LRTI but it takes a great deal of knowledge and expertise to rule out all the other serious potentially life threatening conditions and their sequelae.
Finally the notion that shoehorning people with expertise from other domains, to fulfil a GP role, may not be a good idea is getting some attention. A paramedic, who is trained to be a paramedic thinks nothing of practising medicine in primary care. The coordinated systemic brainwashing from the DHSC and NHSE in making people think they are capable of working outside of what they were trained for is clear as day. In no other area of expertise would this be acceptable. The extent the government will do to save money is laughable.
> In no other area of expertise would this be acceptable
As you could see when the presenter made this very point and the paramedic's brain immediately broke due to the cognitive dissonance it forced on them.
> the patient feels heard and they ask for me the next time they come.
This is such a shitty viewpoint. Of course, rapport with the patient is important - it’s drilled into us from day 1 of med school.
But how much is the number of smiles at the patient in the first 10 minutes of the consultation going to matter when they’re dying because you’ve misdiagnosed their PE as anxiety?
You cannot use patients wanting to see you as justification for your existence. They can’t verify that you’re doing the very thing they’ve come to you for. The only thing they can go off is stuff that doesn’t really matter as much in the grand scheme of things.
James response really summed it up well ‘you might be a good paramedic but I’d rather have the good doctor thanks’.
Patients want to see them because they do every needless test they ask for and make every needless referral they want. They don't like doctors telling them they don't need a full body MRI.
Lower respiratory tract infections are simple and have their own diagnostic criteria that doesnt require medicine/medical knowledge?!?
Keep marinating the population in amoxicillin and doxycycline.
Not even that sometimes. A PA saw a friend of mine with a LRTI. Started him on amoxicillin which didn’t work, but wanted to wait for blood tests before starting doxycycline. That delay ended up with him needing to spend 5 days in hospital with pneumonia.
Can't follow curb65 protocol if you don't have urea. If you dont tick the urea box, mdcalc doesn't give you an answer, so unfortunately the patient cant be diagnosed with anything at all.
Unfortunately as doctors we're burdened with 'medical training' and can 'make clinical decisions' based on 'years of experience and training'.
There's no protocol to follow for that.
So sorry to hear about his story. Hope your friend is better now 🤗
Yeah a lot more people are affected by these pseudodoctors including myself and my parents, we gotta keep educating boss.
The rhetorical device of saying that 'this is a bit tin foil hat' was a fantastic technique by the caller. It really draws you in and encourages you to keep an open mind about the explanation she's about to give. This gave her space to explain a structural analysis of the problem which listeners are probably less receptive too. Fantastic speaker. Well done whoever this is!
Playing MAP bingo with the paramedic - "project fear", "glad you're not a doctor, you listen...", "doesn't matter that I haven't studied medicine", "studied medicine vocationally", "cost effective" and "be kind" shite. I'm fed up of these cosplayers playing false equivalence with a 5-6 year degree with high entry requirements then many years of service-provision ladden training. Uni of life shouldn't be applicable to goddamn medicine. I can't pretend to be a medical registrar because I was a locum SHO for a few years, can I?
How on earth is being a paramedic relevant experience for the majority of GP work? I don't think you need to know NICE guidelines on HTN or red flags for cancer. How useful is being great at ALS in GP really? It's also comical that simultaneously to this that the paramedic services also rely upon [GP opinions](https://www.pulsetoday.co.uk/news/urgent-care/ambulance-crews-bullying-practices-to-access-gp-warn-lmcs) to dump the medicolegal responsibility of patients onto someone else. Like doctors are GMC buckaroos.
The way things are these days most of what we do is primary care. However we mostly bumble through it and hope for the best. Some people put the effort in to learn, but a large amount don't.
Yeah, also a paramedic here, turned med student, though I still do primary/urgent care shifts while studying. I'd say the patients in primary care are sicker on average than those I'd go to on an ambulance.
That said, I think I could count on one hand the number of paramedics I know who I think could safely work in primary care - I've lost count of the actual number who are working there.
Uni prepared for primary care MSK, but other key things (particularly anything abdominal-related) was pretty woeful - I don't think for instance that we really covered pancreatitis at all beyond Grey Turner/Cullen's sign, or covered gallstones at all, for example.
Oh this was actually so good!! Well done to the F1 trainee who spoke so well and was so calm.
And listening to the paramedic speak - it makes it clear that not knowing their own limitations is a common theme.
The garbage the paramedic came out with is what all MAPs and ACPs think. They really believe they are doctor equivalents and can replace doctors. This is mainly because ladder-puller consultants have convinced them of this.
He was a bit of a prune during the corbyn times, but he's come back round to me again.
I completely understand his debate style is grating though, even turns off people on the same side at times.
The paramedic sees a patient and asks if they are happy with his diagnosis and decide if they want to see a doctor. When has the public ever been a good judge of these things. That logic is seriously flawed. He thinks he’s as good as a doctor without the studying and breadth of experience.
He sees emergencies as a paramedic, doesn’t make him qualified to treat chronic illnesses as a GP does. As a paramedic, his job is to stabilise people till they are seen by a doctor later on. He shouldn’t be the final line of defence.
Holy mother of god. That paramedic is an assassin in green clothing.
When the main points of argument are ‘we listen’ (so does a priest, but you don’t advocate for them to run a clinic), people like me (I like my postman, but I don’t want him operating on my mother), and ‘I am cheap’ (so’s my old man, but I don’t want him interpreting my ECG), then what the hell do you actually add?!
"Criteria to diagnose a chest infection" is very telling here. This is the essence of tickbox diagnosis where your "criteria" (what criteria does he mean, anyway) is used to identify one thing, and you have no idea what you could be missing, nor why the criteria exists, or what things could masquerade as your "criteria".
Like with my patient who for 6 weeks was sent back and forth between an ANP at her GP practise to the ANP run DVT service for her swollen legs. Turns out the cause of bilateral leg swelling is not bilateral DVTs. Turns out in this case it was cancer.
Paramedic talking about the LRTI is the exact reason we need doctors.
If all you have in your diagnostic milieu for cough is LRTI or asthma, then how the hell are you supposed to identify the stuff that presents in a similar way but isn’t those things? Cough is such a common presentation, you do actually see zebras from time to time.
Medicine is easy if you diagnose everything as a chest infection.
The views of that overconfident and actually quite condescending paramedic are generally terrifying.
I absolutely applaud the analogy with the pilot there. It's life and death situation we're talking about here, the stakes are high. People NEED the pilot / doctor to know what they are doing. Doesn't matter if it was a minor chest infection or just a 1 hour flight. We want the pilot/doctor to be the safest person in the world because that is our lives at stakes here. "it doesn't matter that I haven't studied medicine" and he said that so confidently SMH.
Next time anyone make any arguments for PA just ask them this "would you get on a plane flown by flight assistant, didn't undergo pilot training, less qualified than real pilot but hey the airline can save cost?"
The Dunning-Kruger is strong with the paramedic. He knows what he knows, but there's a distinct lack of appreciating the unknown unknowns. There may only be "so many criteria" in a chest infection, but that's all on the assumption it truly is a "simple chest infection". It's that assumption that is dangerous and requires the medical training to really understand if it is or not.
The brass neck of that paramedic , the confidence he had. That’s crazy to me. The constant pandering to these low level professionals, yes I said it LOW LEVEL professionals is what has caused this confidence to play Dr
I would imagine they encourage this behaviour. Weak spineless GPs is what has lead to the demise of our beautiful respected profession, the ones I imagine this paramedic is surrounded by are the type who pander to his delusional attitude
That is my fear.
I just genuinely can't fathom how any GP could listen to a non-doctor saying that a good paramedic is a better GP than a good doctor and that they "don't need to have studied medicine" and not have their eyes pop out their head.
Third world health care
Actually not even that
The reason noctors are flooding hospitals and GP practices are purely a cost saving measure
Patients come second in this equation
AAs, PAs, prescribing paramedics, surgical practitioners and other noctors should be tarred with the label of cranks and intent on harming patients for their own self fulfilment while using doctors as liability shields
Pushed by this incompetent Tory government, organisations like the IEA and consulting firms
We just need to boycott the lot of them, refuse to accept their referrals, refuse to prescribe or request scans for them, refuse to supervise their "students" and eliminate them one by one locally from our departments
The only way this experiment continues is through doctors engaging with them
Disengage
>Pushed by this incompetent Tory government,
Sigh, don't make me tap the sign. Same shit happening in Wales and Scotland.
All politicians are cheapening healthcare.
I can't help feeling that this is a consequence of the gradual development of a corporate ideology. It's happening in all public services.
The loss of an individual life due to a misdiagnosis or error has little value in the corporate schema. What corporate NHS wants is "good enough" - 90% of pneumonia presentations correctly diagnosed? Good enough. Achieved at a lower financial cost that training lots of doctors? Fantastic. Yes, some people will die who might otherwise not do, but that's the cost of doing business. As long as the general public is happy enough - better access, more consultation time, clear protocols - then the political cost of the occasional wrongful death is minimal, and anyway not the fault of government, just the one making the error.
Doctors? Well, we'll keep those for the rich and platinum insurance providers. True, fewer will be UK trained, but so what? The general public can just slum it, and we'll keep the specialists for the "important" people.
“if at the end you think what we’ve done here today isn’t right, then I’ll make an appointment with a doctor” apparently patients need to learn medicine now :(
The paramedic sounds worse every time I listen to his nonsense. He is actually suggesting that non doctors and not studying medicine is better for patient care.
You don't know what you don't know. You can be so ignorant to something and have the inability to know you're ignorant to it. Wisdom is knowing this.
People need to remember this when they're cosplaying doctors
And because they're pretending, they're scared of showing weakness and asking for help or advice from the people who actually *do* know.
Obviously I disagree with a lot of what the paramedic said. I felt like his argument was 'im good because patients are happy to see me and come back to me'
I don't feel like that's evidence of good medicine. He can be a great communicator or listener, which is part of medicine, but if he's just churning out Amoxicillin scripts for everyone then sure people are going to be happy to see him.
# Another presenter suggests criticism of PAs is driven by doctors protecting their own financial interests... [https://x.com/LBC/status/1805638284711760094](https://x.com/LBC/status/1805638284711760094)
who denies that? it's partly true – doctors aren't getting jobs due to direct replacement by underqualified and undertrained roles, of course it's partially a financial interest in that regard.
I mean the bottom line is that we DO have a financial interest, because the whole point of these quacks is to deliberately undercut doctors with a low cost low skill higher risk alternative… there’s nothing unreasonable about us protecting our financial interest especially when it’s also in the best interests of patients to be looked after by people with the appropriate skills and training to do that safely - not some geography graduate with a one day a week Mickey Mouse masters.
More than one reason can motivate a decision.
PAs are worse for patients and worse for healthcare, but the less of them there are the less likely they'll replace a job I may want to compete for some day.
Paramedic working as a GP and saying it doesn’t matter he didn’t study medicine is a worse example of Trent in midfield and it not mattering he never played there.
Daily Mail (I know, I know...) article from Nov 2023 that features a list of unsubstantiated PA errors.
https://www.dailymail.co.uk/health/article-12738457/amp/Breast-cancer-tragedy-shows-vital-health-chiefs-clamp-physician-associates-just-TWO-YEARS-training-MoS-handed-dossier-400-reports-concerned-doctors.html
Sorry I'm an Australian doctor but why the fuck are paramedics working in general practice, I am SO CONFUSED.
Like.. I am very confused as to how the scope of practice of a paramedic/ their knowledge base even remotely crosses over into GP?
How do they assess and manage diabetes???
Same for thyroid issues.
What do they know about screening for things like breast cancer, cervical cancer, CR ca?
What do they know about antenatal care?
Skin cancer removals?
HELP ME UNDERSTAND THIS MAKES NO SENSE.
"I say to them if they're not happy with the diagnosis we can go and organise an appointment with the doctor."
But they won't know that will they? If the patient is a layperson they are trusting you and you're just bouncing the responsibility of a correct diagnosis back to them? Absolutely bizarre sentence.
"You don't need to see a doctor."
If I ask to see a doctor, you will get me a doctor. I pay my taxes, and I will see who I want to see.
This has been my response for my kids or my own health. My wife doesn't go that far...but I wouldn't want to die by the hands of some ignorant and arrogant person who is delusional enough to think they are as good as doctors.
This is part of a wider demographic replacment of the UK's working and middle class. Historically doctors were created from bright young adults who wanted to get on in life and were triained over a period of around 5y undergraduate and 5y postgraduate studies. Medicine like all professions was a great social equaliser. This system was so highly effective and at one point the NHS was indeed the envy of the world. It was however quite expensive and the global powers that be prefer to service the needs of the general public with a cheap low skilled workforce, many who are economic imigrants from abroad (not that that is a bad thing per se). Outcomes will be worse under the new model but it's just part of the general degredation and collapse of the West.
He may very well be a decent paramedic and competent at managing various simple things, but it comes back to the central point of why you just wouldn’t have another fully qualified doctor instead.
Qualified physicians are used in the US. We have Nurse Practitioners who do this exact job
The UK has literally for the past few decades been watching what countries like the US does in terms of healthcare, in terms of what cost cutting they can do, and is incorporating that into the NHS/ eventual privatised form of healthcare.
Pray someone wakes up and realizes that we need to get funding back into social care and the NHS asap in order to save it.
And for those who want a privatized healthcare system, it only works if you can afford it, just remember that. And the UK government is taking the worse parts of the US healthcare system and incorporating it into the NHS, what parts of the US insurance features do you think the UK government will borrow next when they NHS becomes privatized?
I congratulate the doctor. She came over very well and explained the situation. Normally James O'Brien drives me mad as he is so polarised. This time maybe because it could affect him he asked for questions and probed both callers and I think non medical people listening will be more informed and inquisitive. It won't stop the progression of PA's as they will become pseudo doctors and eventually morph into doctors. They are cheaper to train and cheaper to employ and can't work anywhere else (though I'm sure the private sector will happily employ them, as they are financially viable to employ (cheaper))and as the real doctors are phased off of the NHS by attrition of poor conditions/pay/work-life balance. Then they will turn the screws on the PA's, no pay progression, more responsibilities and they will follow the proformas that the consultants are being encouraged to write. And if they followed an agreed proforma and something goes wrong they can't sue as the proforma was followed. The remaining doctors who used clinical acumen as the proforma didn't apply to that patient will be struck off if something untoward happened to the patient or bullied by the managers as the proforma wasn't followed.
I hope it isn't true and the strikes get a result, but I think we all know Labour will say "the country can't afford it" and we need an extra 60,000 clinic appointments and the waiting lists back down and put a few coins in the pot and expect miracles and the poor doctors weighed down with £100k of debt and a mortgage and a family, with kids at a school they love and an unwell parent can't upsticks to another country and aren't skilled/brave enough to start a new career course with more student loan/debt. The governments aren't stupid this has been going on for years. All we can expect is for the Labour government to remortgage our great grand children with more PFI's to build hospitals and schools. And that's the best case scenario as I'm sure they have their eyes on your NHS pension pot, lifetime allowance and tax free lump sum and your state pension entitlement.
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‘It doesn’t matter that I haven’t studied medicine..’ truly terrifying indeed.
"I'd rather have a good doctor than a good paramedic practitioner" "No I don't think you're right" Jesus fucking Christ.
The Party told you to reject the evidence of your eyes and ears. It was their final, most essential command.
They are all the same
Biased and not knowing what they don't know. Would they be happy with no doctor being involved in their care, if they were hospitalised?
I didn’t actually have a huge issue with paramedics in GPs until I heard that guy speak. I really don’t feel he’s helped his cause.
I’ve had some of the worst experience with paramedics and ACPs masquerading as duty doctor for GP practices. There’s no appreciation for unknown unknowns. After seeing 100 LRTIs and 100 ?DVTs some really do think they’ve cracked medicine. Sadly when something slightly out of the ordinary presents it’s left for others to mop up the mess.
Classic noctor. Reduces medicine to criteria and gets it wrong. I’ve not see one doctor use a set of criteria to diagnose a chest infection. Yes we use CURB-65 to stratify severity/mortality but not to diagnose it. It’s diagnosed clinically. Urea 9? Fuck must be a chest infection. No that’s not how it works 😂
Yeah he came In guns blazing but all that was coming out were blanks
[удалено]
Removed: Rule 1 - Be Professional
He could px himself sildenafil 🤣
Freakingg hate paramedics in my practice. Every 15 minutes he'd ask for another amoxicillin prescription. Can prescribe my ars Edited to be more civilised
> Can prescribe my ars Just on that front, I should say that many can indeed prescribe independently (apart from certain CDs), though not all jobs make that a requirement.
Embarrassing. Definitely didn't help the cause.
Yeah, it was a pretty alarming exchange.
It was great. Finally an open and very public example of why this experiment cannot be allowed to continue. No member of the public listening to that came away thinking anything other than they would ask for a doctor.
I'm usually pretty on side with paramedics but that guy is a moron. I reckon road paramedics probably listen to him and think he's a moron too.
Certainly was my experience of these muppets in the ambulance service. They weren't often well-regarded.
Nah they can be horrendous. Transplanted from their area of expertise where they're incredible into one they don't know anything about but often carry a massive ego. One sod in my area who kept trying to refer mechanical back pain to SDEC as if I've got some magical solution that I'm just keeping from them.
It might not take a lot to diagnose a LRTI but it takes a great deal of knowledge and expertise to rule out all the other serious potentially life threatening conditions and their sequelae.
Well said
Finally the notion that shoehorning people with expertise from other domains, to fulfil a GP role, may not be a good idea is getting some attention. A paramedic, who is trained to be a paramedic thinks nothing of practising medicine in primary care. The coordinated systemic brainwashing from the DHSC and NHSE in making people think they are capable of working outside of what they were trained for is clear as day. In no other area of expertise would this be acceptable. The extent the government will do to save money is laughable.
> In no other area of expertise would this be acceptable As you could see when the presenter made this very point and the paramedic's brain immediately broke due to the cognitive dissonance it forced on them.
> the patient feels heard and they ask for me the next time they come. This is such a shitty viewpoint. Of course, rapport with the patient is important - it’s drilled into us from day 1 of med school. But how much is the number of smiles at the patient in the first 10 minutes of the consultation going to matter when they’re dying because you’ve misdiagnosed their PE as anxiety? You cannot use patients wanting to see you as justification for your existence. They can’t verify that you’re doing the very thing they’ve come to you for. The only thing they can go off is stuff that doesn’t really matter as much in the grand scheme of things. James response really summed it up well ‘you might be a good paramedic but I’d rather have the good doctor thanks’.
Patients want to see them because they do every needless test they ask for and make every needless referral they want. They don't like doctors telling them they don't need a full body MRI.
Might as well bring some chicken cuz he sounds like a waiter serving a customer
Lower respiratory tract infections are simple and have their own diagnostic criteria that doesnt require medicine/medical knowledge?!? Keep marinating the population in amoxicillin and doxycycline.
Not even that sometimes. A PA saw a friend of mine with a LRTI. Started him on amoxicillin which didn’t work, but wanted to wait for blood tests before starting doxycycline. That delay ended up with him needing to spend 5 days in hospital with pneumonia.
Can't follow curb65 protocol if you don't have urea. If you dont tick the urea box, mdcalc doesn't give you an answer, so unfortunately the patient cant be diagnosed with anything at all. Unfortunately as doctors we're burdened with 'medical training' and can 'make clinical decisions' based on 'years of experience and training'. There's no protocol to follow for that.
Surely they just use CRB-65 instead? Although it then raises the issue of acceptable risk.
that sounds like a clinical decision. Refer to respiratory.
So sorry to hear about his story. Hope your friend is better now 🤗 Yeah a lot more people are affected by these pseudodoctors including myself and my parents, we gotta keep educating boss.
The rhetorical device of saying that 'this is a bit tin foil hat' was a fantastic technique by the caller. It really draws you in and encourages you to keep an open mind about the explanation she's about to give. This gave her space to explain a structural analysis of the problem which listeners are probably less receptive too. Fantastic speaker. Well done whoever this is!
She’s very vocal on twitter. Doing a great job
Playing MAP bingo with the paramedic - "project fear", "glad you're not a doctor, you listen...", "doesn't matter that I haven't studied medicine", "studied medicine vocationally", "cost effective" and "be kind" shite. I'm fed up of these cosplayers playing false equivalence with a 5-6 year degree with high entry requirements then many years of service-provision ladden training. Uni of life shouldn't be applicable to goddamn medicine. I can't pretend to be a medical registrar because I was a locum SHO for a few years, can I? How on earth is being a paramedic relevant experience for the majority of GP work? I don't think you need to know NICE guidelines on HTN or red flags for cancer. How useful is being great at ALS in GP really? It's also comical that simultaneously to this that the paramedic services also rely upon [GP opinions](https://www.pulsetoday.co.uk/news/urgent-care/ambulance-crews-bullying-practices-to-access-gp-warn-lmcs) to dump the medicolegal responsibility of patients onto someone else. Like doctors are GMC buckaroos.
The way things are these days most of what we do is primary care. However we mostly bumble through it and hope for the best. Some people put the effort in to learn, but a large amount don't.
Yeah, also a paramedic here, turned med student, though I still do primary/urgent care shifts while studying. I'd say the patients in primary care are sicker on average than those I'd go to on an ambulance. That said, I think I could count on one hand the number of paramedics I know who I think could safely work in primary care - I've lost count of the actual number who are working there. Uni prepared for primary care MSK, but other key things (particularly anything abdominal-related) was pretty woeful - I don't think for instance that we really covered pancreatitis at all beyond Grey Turner/Cullen's sign, or covered gallstones at all, for example.
Oh this was actually so good!! Well done to the F1 trainee who spoke so well and was so calm. And listening to the paramedic speak - it makes it clear that not knowing their own limitations is a common theme.
Overconfidence is a dangerous thing
The garbage the paramedic came out with is what all MAPs and ACPs think. They really believe they are doctor equivalents and can replace doctors. This is mainly because ladder-puller consultants have convinced them of this.
Can’t stand James normally but that cross examination of the paramedic was excellent
He was a bit of a prune during the corbyn times, but he's come back round to me again. I completely understand his debate style is grating though, even turns off people on the same side at times.
The paramedic sees a patient and asks if they are happy with his diagnosis and decide if they want to see a doctor. When has the public ever been a good judge of these things. That logic is seriously flawed. He thinks he’s as good as a doctor without the studying and breadth of experience. He sees emergencies as a paramedic, doesn’t make him qualified to treat chronic illnesses as a GP does. As a paramedic, his job is to stabilise people till they are seen by a doctor later on. He shouldn’t be the final line of defence.
Wow Just wow, that second caller is absolutely going to kill someone.
Holy mother of god. That paramedic is an assassin in green clothing. When the main points of argument are ‘we listen’ (so does a priest, but you don’t advocate for them to run a clinic), people like me (I like my postman, but I don’t want him operating on my mother), and ‘I am cheap’ (so’s my old man, but I don’t want him interpreting my ECG), then what the hell do you actually add?!
Oh I'm going to use that priest line!!
Everybody wanna be big but nobody wants to lift no heavy ass weights
But the consultants are saying ‘you’re a big strong boy aren’t you!’ so it must be fine right
"Criteria to diagnose a chest infection" is very telling here. This is the essence of tickbox diagnosis where your "criteria" (what criteria does he mean, anyway) is used to identify one thing, and you have no idea what you could be missing, nor why the criteria exists, or what things could masquerade as your "criteria". Like with my patient who for 6 weeks was sent back and forth between an ANP at her GP practise to the ANP run DVT service for her swollen legs. Turns out the cause of bilateral leg swelling is not bilateral DVTs. Turns out in this case it was cancer.
Paramedic talking about the LRTI is the exact reason we need doctors. If all you have in your diagnostic milieu for cough is LRTI or asthma, then how the hell are you supposed to identify the stuff that presents in a similar way but isn’t those things? Cough is such a common presentation, you do actually see zebras from time to time.
Medicine is easy if you diagnose everything as a chest infection. The views of that overconfident and actually quite condescending paramedic are generally terrifying.
Most of the noctors think like this paramedic. They all need to be binned
I absolutely applaud the analogy with the pilot there. It's life and death situation we're talking about here, the stakes are high. People NEED the pilot / doctor to know what they are doing. Doesn't matter if it was a minor chest infection or just a 1 hour flight. We want the pilot/doctor to be the safest person in the world because that is our lives at stakes here. "it doesn't matter that I haven't studied medicine" and he said that so confidently SMH. Next time anyone make any arguments for PA just ask them this "would you get on a plane flown by flight assistant, didn't undergo pilot training, less qualified than real pilot but hey the airline can save cost?"
The Dunning-Kruger is strong with the paramedic. He knows what he knows, but there's a distinct lack of appreciating the unknown unknowns. There may only be "so many criteria" in a chest infection, but that's all on the assumption it truly is a "simple chest infection". It's that assumption that is dangerous and requires the medical training to really understand if it is or not.
The brass neck of that paramedic , the confidence he had. That’s crazy to me. The constant pandering to these low level professionals, yes I said it LOW LEVEL professionals is what has caused this confidence to play Dr
Wonder how the GPs at the practice he's employed at felt listening to it. You'd hope they were cringing themselves inside out.
I would imagine they encourage this behaviour. Weak spineless GPs is what has lead to the demise of our beautiful respected profession, the ones I imagine this paramedic is surrounded by are the type who pander to his delusional attitude
That is my fear. I just genuinely can't fathom how any GP could listen to a non-doctor saying that a good paramedic is a better GP than a good doctor and that they "don't need to have studied medicine" and not have their eyes pop out their head.
It’s reached a point in my mind where it’s become satire .
Third world health care Actually not even that The reason noctors are flooding hospitals and GP practices are purely a cost saving measure Patients come second in this equation AAs, PAs, prescribing paramedics, surgical practitioners and other noctors should be tarred with the label of cranks and intent on harming patients for their own self fulfilment while using doctors as liability shields Pushed by this incompetent Tory government, organisations like the IEA and consulting firms We just need to boycott the lot of them, refuse to accept their referrals, refuse to prescribe or request scans for them, refuse to supervise their "students" and eliminate them one by one locally from our departments The only way this experiment continues is through doctors engaging with them Disengage
>Pushed by this incompetent Tory government, Sigh, don't make me tap the sign. Same shit happening in Wales and Scotland. All politicians are cheapening healthcare.
That was a fairly good call by Eilidh. I find her twitter posting obnoxious sometimes but this here is a proper job. Hope she gets elected.
I can't help feeling that this is a consequence of the gradual development of a corporate ideology. It's happening in all public services. The loss of an individual life due to a misdiagnosis or error has little value in the corporate schema. What corporate NHS wants is "good enough" - 90% of pneumonia presentations correctly diagnosed? Good enough. Achieved at a lower financial cost that training lots of doctors? Fantastic. Yes, some people will die who might otherwise not do, but that's the cost of doing business. As long as the general public is happy enough - better access, more consultation time, clear protocols - then the political cost of the occasional wrongful death is minimal, and anyway not the fault of government, just the one making the error. Doctors? Well, we'll keep those for the rich and platinum insurance providers. True, fewer will be UK trained, but so what? The general public can just slum it, and we'll keep the specialists for the "important" people.
Just listening now, this F1 is far more coherent than most doctors I’ve heard speak out on this issue. Well done, her.
“if at the end you think what we’ve done here today isn’t right, then I’ll make an appointment with a doctor” apparently patients need to learn medicine now :(
The paramedic sounds worse every time I listen to his nonsense. He is actually suggesting that non doctors and not studying medicine is better for patient care.
I didn't have an opinion on paramedics in GP surgeries until today. Now I don't think they should be there.
The F1 is DrEilidhMaria
You don't know what you don't know. You can be so ignorant to something and have the inability to know you're ignorant to it. Wisdom is knowing this. People need to remember this when they're cosplaying doctors And because they're pretending, they're scared of showing weakness and asking for help or advice from the people who actually *do* know.
Obviously I disagree with a lot of what the paramedic said. I felt like his argument was 'im good because patients are happy to see me and come back to me' I don't feel like that's evidence of good medicine. He can be a great communicator or listener, which is part of medicine, but if he's just churning out Amoxicillin scripts for everyone then sure people are going to be happy to see him.
How many people do we think have ended up in ITU after seeing that paramedic in a GP and been sent home .....
🙌🏼🤯 what a dolt.
Omg I spat out my moet when he told him id rather have a good doctor than a good paramedic prac 😭
This made me deeply deeply uncomfortable Great job from the doctor, really articulated herself well
# Another presenter suggests criticism of PAs is driven by doctors protecting their own financial interests... [https://x.com/LBC/status/1805638284711760094](https://x.com/LBC/status/1805638284711760094)
who denies that? it's partly true – doctors aren't getting jobs due to direct replacement by underqualified and undertrained roles, of course it's partially a financial interest in that regard.
I mean the bottom line is that we DO have a financial interest, because the whole point of these quacks is to deliberately undercut doctors with a low cost low skill higher risk alternative… there’s nothing unreasonable about us protecting our financial interest especially when it’s also in the best interests of patients to be looked after by people with the appropriate skills and training to do that safely - not some geography graduate with a one day a week Mickey Mouse masters.
Yes I am upset that I can't be a locum to have flexible working hours and be with my children anymore
This is fine, it's an industrial relations issue AND a patient safety issue, both of which go hand in hand.
Ask Swarbrick who he'll be seeing for his own medical problems.
Erm yes. What’s wrong with that. This isn’t the USSR.
More than one reason can motivate a decision. PAs are worse for patients and worse for healthcare, but the less of them there are the less likely they'll replace a job I may want to compete for some day.
Paramedic working as a GP and saying it doesn’t matter he didn’t study medicine is a worse example of Trent in midfield and it not mattering he never played there.
LBC finally thank you for seeing the light!!
Daily Mail (I know, I know...) article from Nov 2023 that features a list of unsubstantiated PA errors. https://www.dailymail.co.uk/health/article-12738457/amp/Breast-cancer-tragedy-shows-vital-health-chiefs-clamp-physician-associates-just-TWO-YEARS-training-MoS-handed-dossier-400-reports-concerned-doctors.html
Damn this Paramedic thinks he’s God’s gift 🙄
Sorry I'm an Australian doctor but why the fuck are paramedics working in general practice, I am SO CONFUSED. Like.. I am very confused as to how the scope of practice of a paramedic/ their knowledge base even remotely crosses over into GP? How do they assess and manage diabetes??? Same for thyroid issues. What do they know about screening for things like breast cancer, cervical cancer, CR ca? What do they know about antenatal care? Skin cancer removals? HELP ME UNDERSTAND THIS MAKES NO SENSE.
"I say to them if they're not happy with the diagnosis we can go and organise an appointment with the doctor." But they won't know that will they? If the patient is a layperson they are trusting you and you're just bouncing the responsibility of a correct diagnosis back to them? Absolutely bizarre sentence.
"You don't need to see a doctor." If I ask to see a doctor, you will get me a doctor. I pay my taxes, and I will see who I want to see. This has been my response for my kids or my own health. My wife doesn't go that far...but I wouldn't want to die by the hands of some ignorant and arrogant person who is delusional enough to think they are as good as doctors.
This is part of a wider demographic replacment of the UK's working and middle class. Historically doctors were created from bright young adults who wanted to get on in life and were triained over a period of around 5y undergraduate and 5y postgraduate studies. Medicine like all professions was a great social equaliser. This system was so highly effective and at one point the NHS was indeed the envy of the world. It was however quite expensive and the global powers that be prefer to service the needs of the general public with a cheap low skilled workforce, many who are economic imigrants from abroad (not that that is a bad thing per se). Outcomes will be worse under the new model but it's just part of the general degredation and collapse of the West.
Why is ‘less qualified’ in inverted commas 😭
He may very well be a decent paramedic and competent at managing various simple things, but it comes back to the central point of why you just wouldn’t have another fully qualified doctor instead.
Qualified physicians are used in the US. We have Nurse Practitioners who do this exact job The UK has literally for the past few decades been watching what countries like the US does in terms of healthcare, in terms of what cost cutting they can do, and is incorporating that into the NHS/ eventual privatised form of healthcare. Pray someone wakes up and realizes that we need to get funding back into social care and the NHS asap in order to save it. And for those who want a privatized healthcare system, it only works if you can afford it, just remember that. And the UK government is taking the worse parts of the US healthcare system and incorporating it into the NHS, what parts of the US insurance features do you think the UK government will borrow next when they NHS becomes privatized?
I congratulate the doctor. She came over very well and explained the situation. Normally James O'Brien drives me mad as he is so polarised. This time maybe because it could affect him he asked for questions and probed both callers and I think non medical people listening will be more informed and inquisitive. It won't stop the progression of PA's as they will become pseudo doctors and eventually morph into doctors. They are cheaper to train and cheaper to employ and can't work anywhere else (though I'm sure the private sector will happily employ them, as they are financially viable to employ (cheaper))and as the real doctors are phased off of the NHS by attrition of poor conditions/pay/work-life balance. Then they will turn the screws on the PA's, no pay progression, more responsibilities and they will follow the proformas that the consultants are being encouraged to write. And if they followed an agreed proforma and something goes wrong they can't sue as the proforma was followed. The remaining doctors who used clinical acumen as the proforma didn't apply to that patient will be struck off if something untoward happened to the patient or bullied by the managers as the proforma wasn't followed. I hope it isn't true and the strikes get a result, but I think we all know Labour will say "the country can't afford it" and we need an extra 60,000 clinic appointments and the waiting lists back down and put a few coins in the pot and expect miracles and the poor doctors weighed down with £100k of debt and a mortgage and a family, with kids at a school they love and an unwell parent can't upsticks to another country and aren't skilled/brave enough to start a new career course with more student loan/debt. The governments aren't stupid this has been going on for years. All we can expect is for the Labour government to remortgage our great grand children with more PFI's to build hospitals and schools. And that's the best case scenario as I'm sure they have their eyes on your NHS pension pot, lifetime allowance and tax free lump sum and your state pension entitlement.
So glad that this is starting to make mainstream media. However, does feel a little too late
Clock that tea