Coroner Raises Concerns Over Physician Associates Following Patient Death

Warning issued about the impact of misdiagnosis by physician associates in NHS hospitals after the death of a 77-year-old woman.

A coroner has issued a warning regarding the role of physician associates (PAs) in NHS hospitals following the misdiagnosis and subsequent death of Pamela Marking, a 77-year-old woman.

Marking was treated in an emergency department but was mistakenly diagnosed with a minor issue instead of severe abdominal complications, leading to her death four days later.

Surrey assistant coroner Karen Henderson has communicated her concerns to health leaders and bodies, including the UK health secretary and NHS England, emphasizing the limited training of physician associates and the public's lack of understanding of their roles.

In a report aimed at preventing future deaths, Henderson recounted that Marking was admitted to East Surrey hospital in Redhill on February 16, 2024, after experiencing severe symptoms, including vomiting blood and abdominal tenderness.

A PA who examined her did not recognize the seriousness of her condition, resulting in her being discharged the same day.

Marking's health deteriorated, and she returned to the hospital two days later, where she underwent surgery for complications from a femoral hernia.

Unfortunately, she died on February 20, 2024. The coroner noted that the PA was allowed to independently handle her diagnosis, treatment, management, and discharge without oversight from a medical practitioner, raising concerns about their capabilities within the healthcare system.

Henderson stated that the designation of 'physician associate' can mislead the public.

Marking's family believed she was treated by a medical doctor, not a PA, and there was no effort from the emergency department or the PA to clarify the difference in training and responsibilities.

This lack of public knowledge about the PA role could hinder patients' and families' requests for opinions from licensed medical practitioners.

In the inquest's conclusion, Henderson indicated that the care Marking received during her initial hospital visit and subsequent anaesthesia issues contributed significantly to her death.

In response to growing safety concerns within the medical community, the UK government launched a review of the role of PAs in the NHS in November.

This review will assess safety protocols and the need for clearer patient communication regarding the limitations of PAs, who are not doctors but can perform certain medical tasks.

Currently, there are approximately 3,500 physician associates and around 100 anaesthetic associates employed in hospitals and general practice settings across England.

PAs are trained for two years and can take patient histories, conduct physical examinations, analyze test results, diagnose illnesses, and contribute to treatment plans, although their training is significantly less extensive than that of physicians.

Philip Banfield, chair of the BMA council, emphasized the necessity of medical doctor involvement for patients like Marking, as doctors are trained more comprehensively to discern complex diagnoses.

He highlighted that the misunderstandings regarding the roles of PAs and doctors could jeopardize patient safety.

A spokesperson for Surrey and Sussex Healthcare NHS Trust asserted their commitment to learning from this case to improve future practices, stating that PAs undergo a recognized training program and function within defined scopes of practice under consultant supervision.

They also mentioned that PAs use designated attire and identification to clarify their roles to patients.

An NHS spokesperson reiterated that PAs are not substitutes for doctors and should operate under appropriate medical supervision, acknowledging the valid concerns surrounding their roles.

The ongoing government review aims to ensure that PAs are utilized correctly within the health service.