There is a fairytale that General Practice (Primary Care) should be like an onion, with patients having to fight through less knowledgeable outer layers until they get deep enough to find someone who knows how to help. But this isn’t our experience. We found letting patients book appointments directly with the most qualified person in the practice that they wanted, actually reduced our workload.
What is going on? Are we an outlier, or does the official fable miss something? Surely PAs with their science degree and diploma are better than patients at knowing if they need to see a doctor. But how are PAs coming to their judgments? Sure, they have more medical knowledge than the average patient. But they only have the sight, sound, touch and smell of their consultation to work out if anything serious is going on.
Patients, on the other hand, have all the sensations in their whole body to guide them. Not only that, but they have this rich data over days or weeks, not just a few minutes. And, since they have only one body to look after they are experts in noticing when it has changed and something is wrong. We should be helping them to recognise problems and decide if they need to see a doctor. If they get it wrong we should teach them do better next time. And they will.
This is not an attack on PAs, they are an incredible resource with general medical knowledge who can help patients with chronic physical and mental illness. They can multiply the effectiveness of doctors by expanding time and support beyond what we can offer. But it is a waste of their time and talent to try and second guess or triage patients.
Patients are not customers, they are partners in creating health in our communities. The only thing they care about is minimising the time to return to maximum possible health. That should be the only standard we care about or measure. Minor illnesses should be defined as those a patient can sort out themselves. For anything else they should see the clinician of their choice.