Physician associates: avoiding blame culture

In Salisbury’s article about the death of a woman who was seen twice by physician associates (PAs), she concludes that the PA training scheme has “led to a dangerous dilution of standards.”1I have worked in NHS acute and emergency care, as a junior doctor and then as a consultant, over a 40 year career. I have seen many junior and senior doctors in both primary and secondary care fail to suspect or consider a diagnosis of pulmonary embolus when that was the underlying condition. I have investigated many cases in which cause of death was a pulmonary embolus and pre-morbid symptoms were sadly misinterpreted. To my knowledge, there is no database that has measured how often a doctor working in the NHS, in the past 40 years, has failed to make or suspect this diagnosis when they were appropriately positioned to do so. It is probably unusual but frequent enough…
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