The healthcare world is a vast spectrum filled with opportunities in numerous professions. One reasonably new one brought to the mix in the UK in the role of Physician Associate. The role of Physician Associate has been around for a long time in America and recently appeared more prominently in the UK health system integrated into hospitals and GP surgeries. I had the excellent opportunity to shadow a PA (I will reference to as JC for confidentiality) for two periods of 2 weeks, each of which I experienced various cases and learning opportunities.

When first meeting JC, we jumped straight into it. I had been previously sent some NICE guidelines and NHS links to read through best to prepare myself for differential diagnosis on common cases he came across at the surgery. JC worked between 5 surgeries, seeing patients who had prebooked appointments at some and other concerns on the day. For the first day, I mainly shadowed him as he saw patients triaged on the phone and then booked an appointment to see him. Some of the main concerns we saw were common colds, coughs, and headaches. JC explained the importance of taking a good patient history to ensure an accurate diagnosis could be made. While working at a GP clinic, I found many people came in to try and get antibiotics; however, antibiotic resistance right now is higher than ever before, and JC had to keep that in mind when diagnosing and getting prescriptions. After the morning and afternoon clinic that finishes at 3 to 4 pm, we have a break until 6.30 pm. In the evening, JC returns and runs a health check and diabetes clinic. He explained that hypertension and diabetes are two of the most significant burdens on the NHS right now. If caught early and managed correctly, numbers could drastically reduce, reducing strain on the NHS. Therefore, every evening, Monday to Friday, and Saturday all day, he and two other PAs run the health check and diabetes clinic.

In health checks, patients over 40 come in every four years to get their height and weight checked. Then, they review some lifestyle questions regarding smoking, drinking, and exercise. They take their pulse rate and blood pressure. Finally, they take a blood sample to check blood HbA1c. If the patient’s blood pressure shows they have hypertension, they then have to fill out a home self-monitoring form and bring it back to the clinic in a week to check if their hypertension is long-term or just a one-off due to nervousness from coming to the clinic. After a week of meticulously observing JC, understanding how he runs a patient consultation, undergoes differential diagnosis, and ensures all is done in a timely fashion, he allowed me to run some patient consultations the following week under his supervision.

The following Monday, I started to run the patient consultation, I felt nervous but excited to put the skills I had learned into action. With the first patient, I asked for their chief concern to grasp an understanding of their visit to the clinic today. JC taught me a technique called ICE (Ideas, Concerns, and Expectations), which ensured all patients left happy and feeling heard. When taking the patient history, I ensured that I covered what their main concerns were and what results they expected. When diagnosing, I spoke to JC about my thought process to come to a conclusion. Here, I was presented with a 5-year-old boy with a wheezing cough and cracking upon auscultation. I suggested to JC that he could have asthma, to which he agreed and spoke to me through the referral process and how prescribing a salbutamol inhaler would be the best course of action. Throughout the consultation, I discussed these concerns and treatment plans with the mother while JC guided me. After this first consultation, this gave me the confidence to excel and continue for the rest of my work experience.

In the evening, during the health check clinic, I ran the health checks again under JC’s supervision. Many patients who came in for these were quite nervous that they were in poor health, so having a short, friendly conversation with them upon arrival made many of them feel at ease. Then, I would take weight and height measurements and input them into the database. Next, I would discuss lifestyle questions with them while simultaneously taking blood pressure and pulse rate. Doing them simultaneously would keep them distracted and calm as they were busy talking. Finally, JC would step in and take the patient’s blood; as I was not qualified to do this, JC spoke me through the entire process and tips and tricks he has picked up to make learning easier when the time comes around. The only problem I encountered was my final patient; he spoke no English when he arrived, and I was unsure how to tackle this issue. JC stepped in to take the lead in the consultation; he phoned a translator to ensure the consultation was translated so everything could run smoothly. He spoke to me about how the translator system worked, how in the area he worked in, there is a high prevalence of non-English speakers, and how this is a vital tool when working in the clinic day to day to ensure justice, one of the four medical pillars to ensure everyone is treated equally.

Over the next week and the proceeding next two weeks, I had numerous opportunities to take blood pressure and pulse rates, use the stethoscope to listen to chests, use the otoscope, partake in abdominal exams, check urine samples, and discuss complex cases with JC and consultants. My experience with JC was highly valuable, teaching me a wide range of skills and how a diagnosis comes about. The techniques I learned when using the different equipment have prepared me for when I go to medical school, so I have a broad understanding of how things work. The opportunity has immensely grown my passion and excited me for my future Medical school placements and career.

I met Dr P just after the handover, where they discussed all the information for the cases that had come in overnight and needed continued care. At this point, they also distribute roles in A&E; you can be in peads, chairs, trolleys, or RAT. On the first day, Dr P and I were in paediatric A&E.

The first morning, we discussed some of the cases that were in A&E peads. To start, a child came in with laboured breathing, and he challenged me, asking what I would give a child that presented with these symptoms. We reviewed how beta-2 agonists such as salbutamol work as a vasodilator via a G protein-coupled receptor mechanism. He explained how these are short-acting and how, for more chronic conditions, steroid-based medication can be used to prevent airway remodeling.

After this, we visited the patient, where a thorough history was taken, and then Dr P began his examination. He used a stethoscope to listen to the child’s lungs and allowed me to. Cracking could be heard down the stethoscope, which indicated inflammation. He discussed the treatment plan and showed me how to write patient notes.

After a child presented with a bump to the head, Dr P went through with me all the neurologic exams that have to be done to rule out brain injury. He also discussed with me the safeguarding measures that must be taken for children with such injuries and what advocating for your patient entails.

Over the following few patients, Dr P showed me how to take a patient history and the importance of it when making an informed diagnosis. We also discussed different prescriptions, and he showed me how he prescribes medication on the computer.

After the first day, Dr P handed over our patients to the night team. He showed me the importance of clear and concise communication during the handover, making sure to give enough detail so that there is no confusion while not giving too much so that it becomes overwhelming.

The next day, I met Dr P for a handover, where we listened to the information on the patients that had come in overnight, and we were on RAT. This is where triaged patients came in, and we examined them and either referred them to a specialist team, sent them for diagnostic testing, or prescribed them medication before discharging them.

This day, the importance of differential diagnosis was highlighted to me by Dr P. We treated a patient who came in with a crush injury to the abdomen. Through this, Dr P took a meticulous patient history and account of the event. The consultant then joined us and did an abdominal exam, explaining the nine different quadrants that need to be examined and the techniques of inspection, palpation, percussion, and auscultation.

• Inspection: It is the visual examination of the external body parts to gather information about the patient’s overall appearance, skin condition, body symmetry, and any visible abnormalities.
• Palpation: It involves using the hands and fingers to feel and touch the patient’s body to assess various characteristics such as texture, temperature, moisture, tenderness, and the presence of masses or abnormalities.
• Percussion: It is a technique that involves tapping the patient’s body with the fingertips. These sounds help assess the underlying structures, such as the density of organs or the presence of fluid or air.
• Auscultation: It involves listening to sounds produced by the body using a stethoscope or other listening devices.

The Dr P discussed with me how all this information can be used to make the treatment plan and how to move forward. He decided sending the patient for a CT scan would be best, which I agreed with.

Next, a woman came in with laboured breathing and chest pains upon a fall; she had a history of cancer and was sent for lung X-rays. We viewed the scan and discovered a mass in the right lung of the woman. This could have been caused due to metastases. Dr P discussed the abnormalities within the scan and explained what I should look for when examining these.

At the end of this day, again, we handed over with the night team, discussing all the patients we encountered during the day to provide them with adequate information to continue care throughout the night. The opportunity that I got to shadow Dr P was incredible. He taught me techniques and knowledge I appreciate and will find valuable through education and my future career. Alongside this, he gave me a view of both sides of the coin, the positives and negatives of the role of a doctor, which opened my eyes to the realities of the medical field.