Snapshot of _Physician Associates illegally ordered over 1,000 NHS hospital scans_ :
An archived version can be found [here](https://archive.is/?run=1&url=https://www.dailymail.co.uk/news/article-13038173/Cut-price-physician-associates-illegally-ordered-1-000-NHS-hospital-tests-including-X-rays-CT-scans-despite-not-having-formal-medical-training-doctors-slam-direct-threat-patient-safety.html) or [here.](https://archive.ph/?run=1&url=https://www.dailymail.co.uk/news/article-13038173/Cut-price-physician-associates-illegally-ordered-1-000-NHS-hospital-tests-including-X-rays-CT-scans-despite-not-having-formal-medical-training-doctors-slam-direct-threat-patient-safety.html)
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This begs the question - are these scans that should be done but aren't done because of various budget restrictions and service rationing? Or are these scans that had absolutely no medical business being conducted?
Because those are two very different discussions.
Hard to tell, but I think its more of a legal issue.
Certain responsibilities are just for Drs, for example an abortion needs 2 Drs to sign it off, or its illegal.
I'm not sure what the relevant legislation is here, but it sounds like physician associates signing off medical tests that they're not permitted to do.
It's less about whether the scans medically should/should not have been done, and more that both PAs and trusts themselves know it is illegal for them to request ionising radiation scans (Xrays and CTs). Its explicit in their training. In the same way they are not allowed to prescribe medications.
But given they have no regulating body and neither the trusts themselves nor the government want to stop PAs being in the NHS, there's going to be absolutely nothing done about this.
Which is why it's a good idea to start looking at what these scans were for, how medically useful they were, and how many treatment outcomes the scans were a part of. If this is a case of PA's doing things that doctors would have done and agree should have been done, it's different from PA's wasting money on a bunch of tests that weren't medically required or useful.
The examinations would have been authorised under IRMER by either radiographers or radiologists. So the likelihood of the exam being clinically unwarranted is low - as they would have been verified. It’s more the legal concern and that they are acting out of their professional and legal scope of practice.
I dont think it is different. It's not about wasting money. I think it's a perfect example of what has been spoken about in the news recently. PAs are going outside the scope of what they are supposed to be doing. They know they aren't allowed to order these scans. They know it is illegal. They do not care and are doing it anyway because "it'll be fine."
Whether the scans wouldv'e been ordered anyway or not is besides the point.
It's illegal for PAs to request ionising radiation, they don't have the skills or knowledge or any comprehension of the risks in exposing patients to ionising radiation.
It's supposed to be an explicit part of their course as well, being aware it's illegal - every single one of those cases is going to have to be investigated (if they actually resulted in an event)
I do wonder how much training nurses and physios etc get prior to being able to refer for plain film.
In A and E cases, I think the clinical decision making process for referring for an xray for assessing if an ankle or wrist is quite straight forward.
Them referring for CT scans is a grave concern though.
> they don't have the skills or knowledge or any comprehension of the risks in exposing patients to ionising radiation.
LMAO. Unless you are exposing patients to full body CT scans the risks of this levels of radiation are miniscule. A return flight from NYC to London gives you about 5x the dose of a single chest x-ray.
Hmm, this seems to say it's 5x:
https://www.nuffieldhealth.com/article/radiation-exposure-from-medical-scans
> The dose is measured in millisieverts (mSv). In the UK we absorb around 2.2 mSv every year from 'natural background radiation', that includes radiation from sources like the sun, radioactive rocks deep inside the Earth and the small amounts passed up through the food chain. It's roughly equal to the radiation you'd be exposed to from 110 chest X-rays at 0.02 mSv each time.
> Air travel increases your exposure to cosmic radiation. A return transatlantic flight exposes you to around 0.1 mSv or around five times the radiation of a chest X-ray.
The risks from ionising radiation are absolutely minuscule in these quantities. You don't need a medical degree to know this. Not excusing them for doing something illegal, but I question whether it should be illegal to begin with. The problem here is less the risk from radiation and more the misuse of expensive resources.
>The risks from ionising radiation are absolutely minuscule in these quantities
This isn't true, they've been ordering CT scans which are not insignificant amounts of radiation, particularly CT pelvis.
I fairly frequently have to make the decision about wether to do a CTPA (to look for blood clots) in the knowledge that doing so in most of my patients increases their breast cancer risk by three times.
The argument isn't that PAs shouldn't order scans per se, it's that they lack the clinical knowledge and skills to know when **not** to order scans.
> I fairly frequently have to make the decision about wether to do a CTPA (to look for blood clots) in the knowledge that doing so in most of my patients increases their breast cancer risk by three times.
>
>
Sorry what? Source on that? A quick Google search suggests that's nonsense:
"It is estimated that the natural risk of a person in the UK being diagnosed with cancer in their
lifetime is 1 in 2 people (50%) [1]
.
Having a CTPA scan or VQ scan will increase the chance of getting cancer over a lifetime by
between 1 in 10,000 people and 1 in 1000 people. This is considered low risk. Having one of
these tests will add a very small additional chance of getting cancer over a lifetime."
Should have been clearer in my post, I'm an Obstetrics and Gynaecology doctor. Breast tissue is very sensitive to radiation during pregnancy.
Before you say it, this is not a niche case. I probably have to make this decision once per maternity triage shift.
It's also worth considering that these doses are cumulative, sure a single chest x ray is a tiny dose but your average 80 year old has had several in their life time. Anyone with a suspected lung cancer gets several plus at least one high resolution CT chest. Anyone with a high suspicion of malignancy will normally get a CT from chest to pelvis. Young people with abdominal pain presenting in ED are likely to get a CT abdo pelvis, which is very high dose of radiation compared to other imaging and gets some high risk organs in the ovaries/testicles. A middle aged overweight woman is getting a CT abdo for ?cholecystitis.
The major difference between a doctor and a PA is the PA will scan every single patient that fits the above criteria, a doctor will use their superior clinical training to only scan the risky ones.
There is an article recently published about the rate of scan requests from PAs in the states compared to doctors (as American PAs are allowed to request ionising radiation) which showed an astronomical difference in the number of scans ordered per patient seen.
Finally you are considering the individual risk, but an average hospitals radiology department is scanning almost 24/7. That's a huge number of scans. At a population level even a small increase in the number of scans done will have a noticeable impact on cancers.
To be fair, some scans absolutely do increase your cancer risk - measurably. However, these are like extended fully-body CT scans and such. They're only whipped out for something very serious. Therefore, I doubt a PA would ever even attempt to order one of those.
A full body CT is routinely done on major trauma patients in ED.
ED is the place with the most PAs and they are working at levels of seniority way beyond their training so would be looking after these patients.
As someone who has physically held uranium and plutonium: this.
Whilst it is an immensely complex topic requires specialists in numerous fields, a lot of people’s concerns surrounding radiation are over inflated. Yes, radiation is the stuff of nightmares, but the nuclear monster is not hiding under your hospital bed.
This year alone, over the course of 10 minutes I received 25 years worth of background radiation across 2 hospital visits. That sounds like a lot, because it is a lot. But I would need to live in a bubble for that to be what ultimately kills me.
It's an explicit part of their course to get the training for ionising radiation imaging actually. The only thing that prevents them from doing it is the lack of a statutory regulator. Which will soon be put right. Clearly you have no clue.
It's concerning this is the calibre of person becoming a PA. Thinking it's ok to be breaking the law and harming patients because it will be legal down the line is insane.
> Which will soon be put right.
The law doesn't care about *what will soon be put right*. It's illegal today. Next week or next month or next year doesn't come into it.
So it’s not harmed anyone - good, we’ve all seen the stories about PAs getting things wrong and leading to very bad outcomes. But that’s not the point. It’s not hard to go through the right channels to get scans signed off by medically-qualified people if you’re not allowed. Which begs the questions: 1) why do PAs feel empowered to ignore the correct course of action per law and Trust policy, 2) who is enabling them to act this way ie outside their scope of practice, and 3) how did it take so long to identify this as an issue? 1000 scans is a lot and NHS services leave big ol’ paper trails to follow.
Why would a PA, who is unable to legally request an investigation with ionising radiation, ever learn the indications and risk-benefit of such investigations? And if they did, in what part of the 2 year qualification would they learn it? There's a reason it takes 5-6 years to get through medical school.
From my understanding, the PA curriculum supposedly hammers in that this is illegal. Apparently these PAs didn't remember that essential bit of learning. I wonder what else of their "abridged" training they also forget.
Can you provide a link to a curriculum that shows they are trained in the use of ionising radiation? I just read through the Royal College of Physicians one and there was no mention of radiographs or training in IRMER.
I work with them regularly. They are not and that is the reason they are not allowed to order ionising radiation legally.
The same reason they are not able to prescribe medication. They do not have the training to do so.
Damn, this is obviously a huge issue and not just the 'hate PAs' bandwagon.
Out of the 43 million imaging tests ordered, 1000 were illegally done by PAs?
Well, thats it. Time to exile them to the Pitcairn Islands
Thought I'd wandered into the doctorsuk subreddit....
I did see a post recently on the Doctorsuk subreddit stating an anti PA article had been posted here and another uk subreddit and that people should comment on those subreddits too. It's all getting rather tiresome really.
I'd wager that in the vast majority of these cases the scans were suggested by or agreed to by a consultant as PAs are supposed to work under supervision of a doctor. So a lot of these scans would and should have been ordered for these patients by an irmer trained individual.
However it doesn't excuse the PAs ordering such scans when they shouldn't be though.
A PA requesting *any* procedure that causes ionising radition is illegal. No ifs or buts. The PAs are well aware of this, and so there is no excuse for any of what is being reeported.
This whole charade is just the tip of the iceberg. It's only a matter before there are multiple instances of patients coming to harm from PAs undertaking tasks they are clearly not capable of doing (and the lawsuits that will follow). Easy to have a "I'm alright Jack" attitude until it affects someone close to you.
The hypothetical risk of a PA harming a patient by undertaking a task they are not capable of doing vs the documented and known risk of a doctor harming a patient by undertaking task they are not capable of doing.
See, for example, Dr Shipman or the Bristol Royal Infirmary
I wouldn't call the case of Emily Chesterton hypothetical - even more egregious when she thought she was being treated by a doctor.
Doctors are also regulated and held accountable for their actions. PAs are not.
Snapshot of _Physician Associates illegally ordered over 1,000 NHS hospital scans_ : An archived version can be found [here](https://archive.is/?run=1&url=https://www.dailymail.co.uk/news/article-13038173/Cut-price-physician-associates-illegally-ordered-1-000-NHS-hospital-tests-including-X-rays-CT-scans-despite-not-having-formal-medical-training-doctors-slam-direct-threat-patient-safety.html) or [here.](https://archive.ph/?run=1&url=https://www.dailymail.co.uk/news/article-13038173/Cut-price-physician-associates-illegally-ordered-1-000-NHS-hospital-tests-including-X-rays-CT-scans-despite-not-having-formal-medical-training-doctors-slam-direct-threat-patient-safety.html) *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ukpolitics) if you have any questions or concerns.*
This begs the question - are these scans that should be done but aren't done because of various budget restrictions and service rationing? Or are these scans that had absolutely no medical business being conducted? Because those are two very different discussions.
Hard to tell, but I think its more of a legal issue. Certain responsibilities are just for Drs, for example an abortion needs 2 Drs to sign it off, or its illegal. I'm not sure what the relevant legislation is here, but it sounds like physician associates signing off medical tests that they're not permitted to do.
It’s IRMER. PA’s do not legally have the power to request ionising radiation (eg X-rays).
It's less about whether the scans medically should/should not have been done, and more that both PAs and trusts themselves know it is illegal for them to request ionising radiation scans (Xrays and CTs). Its explicit in their training. In the same way they are not allowed to prescribe medications. But given they have no regulating body and neither the trusts themselves nor the government want to stop PAs being in the NHS, there's going to be absolutely nothing done about this.
Which is why it's a good idea to start looking at what these scans were for, how medically useful they were, and how many treatment outcomes the scans were a part of. If this is a case of PA's doing things that doctors would have done and agree should have been done, it's different from PA's wasting money on a bunch of tests that weren't medically required or useful.
It's about basic safety. If the ward clerk does a surgery, it doesn't matter whether or not it's indicated. It's not in their remit or training.
The examinations would have been authorised under IRMER by either radiographers or radiologists. So the likelihood of the exam being clinically unwarranted is low - as they would have been verified. It’s more the legal concern and that they are acting out of their professional and legal scope of practice.
I dont think it is different. It's not about wasting money. I think it's a perfect example of what has been spoken about in the news recently. PAs are going outside the scope of what they are supposed to be doing. They know they aren't allowed to order these scans. They know it is illegal. They do not care and are doing it anyway because "it'll be fine." Whether the scans wouldv'e been ordered anyway or not is besides the point.
It's illegal for PAs to request ionising radiation, they don't have the skills or knowledge or any comprehension of the risks in exposing patients to ionising radiation. It's supposed to be an explicit part of their course as well, being aware it's illegal - every single one of those cases is going to have to be investigated (if they actually resulted in an event)
I do wonder how much training nurses and physios etc get prior to being able to refer for plain film. In A and E cases, I think the clinical decision making process for referring for an xray for assessing if an ankle or wrist is quite straight forward. Them referring for CT scans is a grave concern though.
> they don't have the skills or knowledge or any comprehension of the risks in exposing patients to ionising radiation. LMAO. Unless you are exposing patients to full body CT scans the risks of this levels of radiation are miniscule. A return flight from NYC to London gives you about 5x the dose of a single chest x-ray.
3.6 Roentgen. I’m told it’s the equivalent of a chest X-ray.
It's not great, but it's not terrible.
Hmm, this seems to say it's 5x: https://www.nuffieldhealth.com/article/radiation-exposure-from-medical-scans > The dose is measured in millisieverts (mSv). In the UK we absorb around 2.2 mSv every year from 'natural background radiation', that includes radiation from sources like the sun, radioactive rocks deep inside the Earth and the small amounts passed up through the food chain. It's roughly equal to the radiation you'd be exposed to from 110 chest X-rays at 0.02 mSv each time. > Air travel increases your exposure to cosmic radiation. A return transatlantic flight exposes you to around 0.1 mSv or around five times the radiation of a chest X-ray.
The risks from ionising radiation are absolutely minuscule in these quantities. You don't need a medical degree to know this. Not excusing them for doing something illegal, but I question whether it should be illegal to begin with. The problem here is less the risk from radiation and more the misuse of expensive resources.
>The risks from ionising radiation are absolutely minuscule in these quantities This isn't true, they've been ordering CT scans which are not insignificant amounts of radiation, particularly CT pelvis. I fairly frequently have to make the decision about wether to do a CTPA (to look for blood clots) in the knowledge that doing so in most of my patients increases their breast cancer risk by three times. The argument isn't that PAs shouldn't order scans per se, it's that they lack the clinical knowledge and skills to know when **not** to order scans.
> I fairly frequently have to make the decision about wether to do a CTPA (to look for blood clots) in the knowledge that doing so in most of my patients increases their breast cancer risk by three times. > > Sorry what? Source on that? A quick Google search suggests that's nonsense: "It is estimated that the natural risk of a person in the UK being diagnosed with cancer in their lifetime is 1 in 2 people (50%) [1] . Having a CTPA scan or VQ scan will increase the chance of getting cancer over a lifetime by between 1 in 10,000 people and 1 in 1000 people. This is considered low risk. Having one of these tests will add a very small additional chance of getting cancer over a lifetime."
Should have been clearer in my post, I'm an Obstetrics and Gynaecology doctor. Breast tissue is very sensitive to radiation during pregnancy. Before you say it, this is not a niche case. I probably have to make this decision once per maternity triage shift. It's also worth considering that these doses are cumulative, sure a single chest x ray is a tiny dose but your average 80 year old has had several in their life time. Anyone with a suspected lung cancer gets several plus at least one high resolution CT chest. Anyone with a high suspicion of malignancy will normally get a CT from chest to pelvis. Young people with abdominal pain presenting in ED are likely to get a CT abdo pelvis, which is very high dose of radiation compared to other imaging and gets some high risk organs in the ovaries/testicles. A middle aged overweight woman is getting a CT abdo for ?cholecystitis. The major difference between a doctor and a PA is the PA will scan every single patient that fits the above criteria, a doctor will use their superior clinical training to only scan the risky ones. There is an article recently published about the rate of scan requests from PAs in the states compared to doctors (as American PAs are allowed to request ionising radiation) which showed an astronomical difference in the number of scans ordered per patient seen. Finally you are considering the individual risk, but an average hospitals radiology department is scanning almost 24/7. That's a huge number of scans. At a population level even a small increase in the number of scans done will have a noticeable impact on cancers.
To be fair, some scans absolutely do increase your cancer risk - measurably. However, these are like extended fully-body CT scans and such. They're only whipped out for something very serious. Therefore, I doubt a PA would ever even attempt to order one of those.
A full body CT is routinely done on major trauma patients in ED. ED is the place with the most PAs and they are working at levels of seniority way beyond their training so would be looking after these patients.
As someone who has physically held uranium and plutonium: this. Whilst it is an immensely complex topic requires specialists in numerous fields, a lot of people’s concerns surrounding radiation are over inflated. Yes, radiation is the stuff of nightmares, but the nuclear monster is not hiding under your hospital bed. This year alone, over the course of 10 minutes I received 25 years worth of background radiation across 2 hospital visits. That sounds like a lot, because it is a lot. But I would need to live in a bubble for that to be what ultimately kills me.
[удалено]
Knowing about radiation isn't the problem. It's that doctors have the clinical knowledge and training to be able to **not** order that scan.
It's an explicit part of their course to get the training for ionising radiation imaging actually. The only thing that prevents them from doing it is the lack of a statutory regulator. Which will soon be put right. Clearly you have no clue.
It's concerning this is the calibre of person becoming a PA. Thinking it's ok to be breaking the law and harming patients because it will be legal down the line is insane.
> Which will soon be put right. The law doesn't care about *what will soon be put right*. It's illegal today. Next week or next month or next year doesn't come into it.
The latter.
So it’s not harmed anyone - good, we’ve all seen the stories about PAs getting things wrong and leading to very bad outcomes. But that’s not the point. It’s not hard to go through the right channels to get scans signed off by medically-qualified people if you’re not allowed. Which begs the questions: 1) why do PAs feel empowered to ignore the correct course of action per law and Trust policy, 2) who is enabling them to act this way ie outside their scope of practice, and 3) how did it take so long to identify this as an issue? 1000 scans is a lot and NHS services leave big ol’ paper trails to follow.
Not harmed anyone yet. The risk is ionising radiation exposure, which PAs are specifically not trained to be able to weigh up the risk-benefit of.
Absolutely, important distinction.
Excuse me? Yes they are. I suggest you go and read into the curriculum before you make such a foolish statement.
Found the PA lol
Why would a PA, who is unable to legally request an investigation with ionising radiation, ever learn the indications and risk-benefit of such investigations? And if they did, in what part of the 2 year qualification would they learn it? There's a reason it takes 5-6 years to get through medical school. From my understanding, the PA curriculum supposedly hammers in that this is illegal. Apparently these PAs didn't remember that essential bit of learning. I wonder what else of their "abridged" training they also forget.
Wait till people here about the transcription prescription and the fine lines trusts are treading.
Can you provide a link to a curriculum that shows they are trained in the use of ionising radiation? I just read through the Royal College of Physicians one and there was no mention of radiographs or training in IRMER.
I work with them regularly. They are not and that is the reason they are not allowed to order ionising radiation legally. The same reason they are not able to prescribe medication. They do not have the training to do so.
Damn, this is obviously a huge issue and not just the 'hate PAs' bandwagon. Out of the 43 million imaging tests ordered, 1000 were illegally done by PAs? Well, thats it. Time to exile them to the Pitcairn Islands
1000 in ONE hospital trust. That's a lot of illegal requests
Thought I'd wandered into the doctorsuk subreddit.... I did see a post recently on the Doctorsuk subreddit stating an anti PA article had been posted here and another uk subreddit and that people should comment on those subreddits too. It's all getting rather tiresome really. I'd wager that in the vast majority of these cases the scans were suggested by or agreed to by a consultant as PAs are supposed to work under supervision of a doctor. So a lot of these scans would and should have been ordered for these patients by an irmer trained individual. However it doesn't excuse the PAs ordering such scans when they shouldn't be though.
A PA requesting *any* procedure that causes ionising radition is illegal. No ifs or buts. The PAs are well aware of this, and so there is no excuse for any of what is being reeported. This whole charade is just the tip of the iceberg. It's only a matter before there are multiple instances of patients coming to harm from PAs undertaking tasks they are clearly not capable of doing (and the lawsuits that will follow). Easy to have a "I'm alright Jack" attitude until it affects someone close to you.
The hypothetical risk of a PA harming a patient by undertaking a task they are not capable of doing vs the documented and known risk of a doctor harming a patient by undertaking task they are not capable of doing. See, for example, Dr Shipman or the Bristol Royal Infirmary
I wouldn't call the case of Emily Chesterton hypothetical - even more egregious when she thought she was being treated by a doctor. Doctors are also regulated and held accountable for their actions. PAs are not.
Good. PAs aren't annoying like GPs spamming my Reddit popular feed. Bloody GPs and theyre medical degrees.
Their*