How to inform when you’ve REALLY been seen by a certified physician

When you’re unwell and make an appointment to see your GP, it’s not unreasonable to assume that the person you end up in a consulting room with is a doctor. Yet, increasingly, that might not be the case.

In fact, you may well be unwittingly discussing your symptoms with someone who doesn’t even have a medical degree.

I’m talking about ‘Physician Associates’ (PAs for short). A poll last week, conducted by Ipsos, found 57 per cent of ­people had either never heard of PAs, or had heard of them but had no idea what they actually did.

Yet I’m sure that many of those polled will have been seen by a PA, without even knowing.

To be clear, a Physician Associate is not a doctor. Their widespread use in the NHS is relatively new, the original idea being that they would ‘assist’ doctors.

However, with the health ­service becoming increasingly stretched, they have started ­taking on more and more clinical responsibilities. This is despite them never having attended medical school but, instead, after achieving

a science-based degree, completing two-year post-graduate training. I find this deeply troubling. In my view, it is unethical and flies in the face of informed consent if you’re under the impression that the person you are discussing private medical concerns with is a doctor.

There’s no doubt that physician associates can be a great help to doctors, but too often they are being used to plug gaps – and the NHS is planning to employ 10,000 of them by 2037!

At medical school, I was taught that the most dangerous thing for a doctor isn’t not knowing something: it’s failing to realise that you don’t know it.

When people are unaware of the limitations of their ­knowledge, it’s all too easy to make mistakes. And this is precisely my concern with PAs.

It generally takes a minimum of 10 years to train a GP.

They will have done five or six years at medical school, two years as a foundation (junior) doctor and a further three years in GP specialist training.

How can a PA compare with that level of experience? It’s no wonder that so many are ­concerned at the boom in PAs, with the Royal College of General Practitioners recently calling for a halt in their recruitment and deployment.

Two years of training cannot equip a PA with as much knowledge and skill as a doctor. This isn’t medical snobbery, it’s just a fact.

I’ve had personal experience of the risks PAs can pose to patients. A year or so ago, my mum was called into her GP surgery to discuss her medication as part of a ‘review’.

I was impressed that they were taking a pro-active approach and checking her medication, as I’ve seen too many people who have been put on repeat prescription inappropriately.

Afterwards, she called me to say that she’d seen a ‘lovely doctor’ who had advised her to stop taking her anticoagulant medication. I was astonished. She has had multiple strokes and it has been impressed on her by several consultants that she must take her anticoagulants for the rest of her life.

It seemed extraordinary for a GP to go against the specific advice of specialists. I was very worried and asked Mum to hold off making any changes and to call the surgery for clarification.

She hadn’t seen a doctor at all, it transpired, but a PA. He’d been diligently following national guidelines on anticoagulants in older people, but had totally failed to understand that you cannot apply a ‘one size fits all’ approach, especially in patients with complex medical histories.

Mum was promptly put back on her medication. But what if her son hadn’t been a doctor? What if she hadn’t told me about it or I hadn’t thought to question who she had actually seen?

For many years now, specialist nurses and advanced nurse ­practitioners have been seeing patients, but they have nursing degrees and years of hands-on experience. More pertinently, the ‘nurse’ part of their title makes it clear they are not doctors.

The same can’t be said for ­physician associates.

While PAs can be good at assessing and treating routine problems, they don’t ­prescribe and cannot request certain diagnostic tests, such as X-rays. They’re currently unregulated and must always work under the supervision of a senior doctor.

NICE (National Institute for Health and Care Excellence) guidelines make it clear that medical professionals should introduce themselves by giving their names and profession, but this rarely happens.

If you want to be certain that the person you are speaking to is a doctor, then my advice is to ask them outright. If you have specifically asked to see a doctor and it turns out that you haven’t been given an appointment with one, then you are well within your rights to complain.

Transparency in medicine is vital. You are entitled to know how qualified the person you are telling your problems to is.

Steer clear of your ex 

After months of speculation, it’s now official that Jennifer Lopez and Ben Affleck have split. Again.

But why risk getting back with someone (JLo and Affleck were first engaged in 2002) when it all ended so badly before?

For some people, self-sabotage is a big factor. They know they’re wrong for each other – and that, perversely, is the appeal.

For others, it’s because there’s something comforting in familiarity. There can even be something intoxicating about being with someone who already knows you.

Sure, the first throes of love, the buzz and excitement, are wonderful, but there’s something to be said for the perceived safety and security of a partner who already ‘gets’ you.

But getting back with an ex is often a sign that we’ve struggled to connect with anyone else, so we try to reconnect with an old flame rather than face life alone.

Yes, occasionally people make it work the second time around. But mostly they’re just repeating the mistakes they made before.

Ralf Schumacher’s ex-wife has broken her silence after he came out as gay, saying she ‘feels used’ and has ‘wasted her best years’ being with him.

When we hear about men who have been married to a woman and then come out, we’re supposed to cheer and call them ‘brave’ for being so ‘honest’.

We rarely think about the woman left behind, who can be left wondering if the entire relationship was a ruse – a lie to cover up his true sexuality.

I say this as a gay man, but I don’t think it’s brave to marry

a woman and then, years later, finally disclose your sexuality. I get that it can be hard to come to terms with being gay, but don’t drag others into your inner turmoil. Don’t ruin someone else’s life because you don’t yet have the courage to be out.

I once had neighbours who were partners for nearly 60 years before they died in their 90s. They lived together, and for decades pretended they were brothers, because it was illegal then to be gay. One was a surgeon, and when a theatre nurse found out he was gay, he was blackmailed until he finally resigned, his career in tatters. But he and his partner remained in a loving, loyal relationship their entire adult lives, despite enduring crushing stigma and prejudice for much of that time.

Those two men were brave.

The new Alzheimer’s drug, lecanemab, won’t be prescribed by the NHS as the benefits are too small to justify the huge cost. But people are desperate and

I hate the idea of families getting into debt to pay for this drug privately.

DR MAX PRESCIBES: THAI TONIC 

Sanuk is the Thai concept of achieving a joyful life. This book shows how to use Sanuk as a guiding principle in our everyday lives, leading to improved happiness all round!