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.

We started with handover, all the Night Shift staff sat with myself and the day general surgery team and spoke through the emergency department intake over the night. They covered approximately 12 cases, discussing symptoms, patient histories, examination patients have undergone and management plans. After the day on call team (consisting of a consultant, reg, SHO and FY1) took notes on all the cases, pagers were handed out and we were off on the morning ward round.

We now started darting from patient to patient in order of importance, where I was practically glued to my FY1’s side. I listened meticulously at each patient consult, which was led by the consultant. The consultant asked each patient questions covering patient history, how they were feeling and discussed with them the ongoing plan of action. I made notes during each patient consultation and on our speed walks between picked Dr Taylor’s brain with questions, on anything I didn’t understand. Dr Taylor was in charge of putting all plans into action, this involved ordering CT scans and blood samples, taking bloods, prescribing medication. Throughout everything he did, he asked me if I understood what he was doing and when I didn’t he explained to me in detail why he made the decision he did.

In the morning we covered how to calculate the amount of IV fluids a person would need and how to decide what type of fluid they need based on whether you need to hydrate intravascular space or intracellular space. We discussed how differential diagnosis’  were made and the management plans that were put in place for the ongoing day for the patient we had visited. Once coming to the end of the ward round the consultant left the hospital, leaving the Reg in charge of the general surgery intakes.

Now was the perfect time to grab coffee before our CT scans came back. We assessed CT scans, many CT scans highlighted diverticulosis, probably the most prevalent cause for people falling under the care of the team I was following today. However, there was one CT that was a black sheep from the crowd, the Reg and Dr Taylor flicked through it, highlighting inflammation around the appendix due to a fecalith blocking the head of the appendix which causes appendicitis. This is something I had covered in my human physiology and medical imaging module in case studies, but was now seeing it right in front of me. This highlighted the importance of pattern recognition in the job. The symptoms, the scan and blood work of the patient all formed the perfect pattern to lead someone to conclude this patient had appendicitis.

Being on call was fast paced and literally changed minute by minute. Rapidly, we now made our way to the OR, so I could get to opportunity to watch an I&D of an abscess. This was the first time I had ever been in an OR, no amount of Grey’s Anatomy on TV and Touch Surgery (a very useful and educational app) prepared me for how exciting and interesting I would find this. Even in this very short lived 25 mins I spent in the OR I was buzzed by the intellect and communication skill that the Reg and SHO showed. I could have stood there all day and watched surgeries for hours on end, mesmerised by everything that happened in there.

After surgery we made our way down to ED to see patients that had come in. Dr Taylor explained to me the importance of taking a patient history. A good patient is the beginning to the detective work in coming to a diagnosis. In general surgery a lot of the time an examination of the abdomen had to be carried out, this is to check for tenderness and guarding, a cough pulse (for hernia’s) and for any internal masses. Finally, if patients had any signs of PR then a rectal examination was mandatory, 80% of colon cancers can be detected in a simple rectal exam, as they are located in the lower portion of the colon, the rectum and the sigmoid colon. After the detective work had been carried out Dr Taylor would come to 1 of 2 conclusions, one- being this is an acute problem and needs to be dealt with today by the general surgery team, or two-  a referral to the GP for further investigation. Then he would write up the notes from the meeting with the patient, prescribe analgesia and then decide on management plans for our next course of action.

One of the final patients we saw was in resus, the patient history was long and Dr Taylor spent an extended amount of time reading through everything to ensure nothing was missed. We assessed the ECG to which I identified there was arterial fibrillation (super excited I got that correct) and then Dr Taylor went on the explain the condition that our patient had and the science behind it. This for me really highlight the link between everything I have so far learnt in uni the previous year and how it linked to these clinical cases, he discussed the Frank Starling Curve and how the shift in it was caused. This is when our Reg joined us and discussed that he would be starting 2 types of antibiotics and this was due to antibiotic resistance, and how different antibiotics work on different parts of the cells. Although much of this was complex and somewhat went straight over my head, the fact that I had covered most of this in my previous year in uni and I was now hearing about it all in a clinical setting excited me, and reinforced that I was working in the right direction towards getting to where I wanted to be.

Finally, handover again, we had full circled and now Dr Taylor was the one handing over to the night staff explaining what we had done in the day and what needed to be done over the ongoing night.

After leaving my full-time job 2 years ago to start my journey to Medicine I definitely have days that I panic ‘Have I made the right decision?’, ‘I have 6 more years in education!’, ‘I will qualify after I’m 30 years old’ and I do question if I made the right decision. That is normal I guess when making a big life changing decision, I was in a comfortable full-time job, a manager, on good money and working my way up in the company…For what, all to start back at square one? But today made me realise, when I came to the end of the 13 hours, physically I was exhausted, but mentally I wanted to stay on and do the night shift, I wanted more. For me today was not just work experience that will sit on my personal statement and help me pave a way into med school, today was the reassurance that I made the right decision. The decision to start working towards hopefully one day having a life-long career in Medicine.

When the first lockdown happened I was furloughed, as a Cabin Manager for easyJet. At this point, the government was allowing everyone to only leave their house if it was mandatory and for 1 hour of excise a day. I felt quite helpless, as I am sure many did. I had many friends and family working as frontline staff and I couldn’t just sit back and do nothing. So I decided to volunteer, I wanted to do literally anything I could do to help, I applied everywhere and a small start-up charity got back to me called Project Wingman. I was run by two Captains one from British Airways and the other from easyJet and when I joined there were no more than 20 of us all together. Their goal was to go around as many hospitals in the UK and open up pop-up lounges in the hospitals to support front-line staff with their mental health during this difficult time. 

I started at North Middlesex University Hospital where we created a cozy safe space for staff to come in on their break and have something to snack and drink on, have a chat, or even be a shoulder to cry on. Quickly our small family of Cabin Crew grew, as more volunteers jumped on board and I was asked to move to Barnet General Royal Free as a Team Leader. Here I would be discussing plans with the hospital management to open up one of our lounges to support their staff and bring in a new group of volunteers and train them up to work in the lounge. I volunteered 3 days a week in the hospital helping staff and another 1 to 2 days I spent contacting companies and collecting donations from them.

Everything from starting to this point happened so fast and I took on a big role very quickly and everything became very overwhelming. However, this experience also brought so many new positives and opportunities into my life. My leadership skill excelled massively, I was leading a team, coordinating donation stock, collecting donation stock, and leasing with hospital management on a daily basis. My communication and admin skills through this were vital, as I was emailing consistently with companies about donations. However, I believe this experience mostly improved my listening and empathy skills, talking to the staff every day, understanding what they were working through, and empathising with them was critical and all in all our main goal of being there. 

Wonderful opportunities were thrown my way, I was interviewed live by the BBC at a Great Ormond Street Hospital conference about high-risk jobs and working during the pandemic. Also, I gave a talk to the Barnet General Radiology department about the transferable skills from aviation to the medical industry, and how we can help them coach claustrophobic patients that are scared of MRI scanners, which is similar to people who are scared of flying. 

This experience not only improved my communication, leadership, time management, and listening skills but opened my eyes to the health care industry and spiked my passion to want to become a doctor.  

Well, I guess this is hello, my beginning, my journey of how I got here…here being Applied Medical Science at UCL and the start of my journey to medicine. 

If only it was as easy as sitting my A levels at 18 and making the right choices that got me here, but then would I be as happy as I am to be here? 

So I guess my beginning was COVID (I know, what a beginning), at this point I was probably somewhere in the clouds…quite literally! I was a flight attendant, a Cabin Manager for easyJet when the first lockdown began. Very quickly my day-to-day changed from holiday hopping to couch potato when Boris told me I couldn’t leave my house, apart from my daily walk. I decided I would volunteer to support the front-line staff since I can not sit still and I joined a charity called Project Wingman. We started as a small little family of flight

attendants that helped NHS staff with their mental health during the pandemic. Our family of cabin crew grew bigger and I opened a support lounge in Barnet hospital as a team leader, where I started heavily interacting with the doctors at this hospital. 

I never knew what I wanted to do forever, at 18 that was always a scary big question that I never knew the answer to. Barnet hospital changed that! Seeing how the doctors helped people every day and the satisfaction it gave them finally answered that big and scary question for me.

I took this opportunity to take voluntary redundancy from flying due to the COVID circumstances and retake my A-Levels, to journey to become a doctor! So now I am here and this is my story I guess…well the beginning of it anyway!